The aim of this prospective randomised controlled trial was to compare changes of vertical palpebral fissure h8 after bilateral lateral rectus (BLR) recession vs unilateral lateral rectus recession/medial rectus muscle scleral plication (RRP) for treatment of intermittent exotropia (IXT). Forty patients aged 4–14 years requiring surgery for poor control, were recruited with basic exotropia of 25–50PD; split to 2 groups of 20. Mean age was 6.6 ±2.3 years. There was no significant difference in groups for baseline characteristics. Bilateral lateral rectus mean recession was 7.8 ±1.8mm. Mean recession for RRP was 6.9 ±1.2mm and plication of 5.4 ±1.3mm. Initial postoperative limitations were documented for 16 in the BLR group and 17 for RRP; non-significant. All resolved by 3 months. There were no significant differences for all postoperative lid measures. There was an initial decrease in marginal reflex distance (MRD) 1 but resolved for all but 1 patient (RRP) by 3 months. Two in the BLR group had increase in MRD2 measures and 3 in the RRP group. Both groups had similar angle results. At 3 months follow-up, 17 in BLR and 19 in RRP were ortho. Every patient was within 10PD of ortho. The authors conclude that lid information is useful in preoperative counselling of patients.
RCT to detect palpebral fissure changes after horizontal strabismus surgery
Reviewed by Fiona Rowe
Palpebral fissure changes after bilateral recession vs unilateral recession-plication of horizontal rectus muscles for correction of intermittent exotropia.
CONTRIBUTOR
Fiona Rowe (Prof)
Institute of Population Health, University of Liverpool, UK.
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