RCT of unilateral vs bilateral surgery for lateral incomitance in exotropia
Reviewed by Fiona Rowe

The purpose of this study was to evaluate and compare the surgical outcomes in the management of lateral incomitance with regard to ocular alignment and change in lateral incomitance in cases of bilateral vs. unilateral strabismus surgery. This was a prospective pilot randomised control trial (RCT) with 40 cases having unilateral surgery and 40 having bilateral surgery. Features of the bilateral surgery group were: mean age 19.1 ±7.8 years, 22 males, 18 females, mean preoperative angle 28.8 ±5.1PD, postoperative angle 5.0 ±1.5PD, mean preoperative lateral incomitance 8.3 ±1.6PD, postoperative lateral incomitance 2.8 ±2.4PD and successful outcome 90%. Features of the unilateral surgery group were: mean age 18.5 ±6.8 years, 20 males, 20 females, mean preoperative angle 29.2 ±5.2PD, postoperative angle 5.1 ±1.4PD, mean preoperative lateral incomitance 8.9 ±1.4PD, postoperative lateral incomitance 3.7 ±2.5PD and successful outcome 85%. There were no significant differences between the two groups for these features. There were no cases of consecutive esotropia and the prevalence of lateral incomitance over a period of 12 months was 19.4%. Both surgical options were equally efficacious in reducing the deviation and improving lateral incomitance. This now requires a phase 3 effectiveness trial.

Comparative study of bilateral vs unilateral strabismus surgery in the management of lateral incomitance in exotropia.
Anand K, Krishnan A, Kumar P, et al.
JOURNAL OF PEDIATRIC OPHTHALMOLOGY AND STRABISMUS
2023;60(3):277-81.