Comparison of bilateral lateral and unilateral recession resection for IXT
Reviewed by Jonathan Chan

This is a retrospective review study of patients between the ages of three and 15 years old with the basic type of intermittent exotropia (IXT) who had strabismus surgery between January 2003 to September 2009. There were 85 patients included in the study; 38 had bilateral lateral recti recessions (BLR-rec) and 47 underwent recession resection (R&R) procedure. The inclusion criteria included: basic type IXT within 10 prism dioptres (PD) before and after 60 min monocular occlusion; between the age of three to 15 years old at the time of surgery; no previous history after surgery or Botulinum toxin injections; best corrected visual acuity in the worst eye was at least 20/40 or better and no interocular difference of visual acuity more than two lines; no anisometropia with difference of greater than 2.50D and no hyperopia or myopia greater than +6.000D spherical equivalent in either eye; largest exodeviation at either distance or near between 15 and 50PD by the prism and alternate cover test with appropriate optical correction; no coexisting vertical deviation greater than 5PD or any evidence of A or V pattern. The postoperative follow-up period was at least six months’ duration. Successful alignment was defined as esophoria / tropia, less than or equal to 5PD to exophoria / tropia, less than or equal to 8PD in primary gaze while viewing distant or near targets. The mean follow-up period was 14.8+/- 9.5 months. In the R&R group, there was a significantly high success rate versus BLR-rec group (85.1% vs 65.8%, p=0.037). The undercorrection rate was significantly lower in the recession and resection group than in the bilateral lateral recti recession group (6.4% vs 23.7%, p=0.023). There was no significant difference in the overcorrection rate between the two groups (10.5% vs 8.5%, p=1.000). The authors suggest that the limitations of the study, including the retrospective nature of the study and the sample size is relatively small. Only a minimum follow-up period of six months was included and the reliability of the study of sensory function parameters were not included because of the inability of some of the younger children who could not manage the Worth four dots test and Titmus stereo test.

Comparison of bilateral lateral rectus recession and unilateral recession resection for basic type intermittent exotropia in children.
Wang L, Wu Q, Kong X, Li Z.
BRITISH JOURNAL OF OPHTHALMOLOGY
2013;97:870-3.