Surgical outcomes of primary recess/resection vs readvancement/recession surgery for exotropia
Reviewed by Fiona Rowe

This study compared the surgical yield of primary lateral rectus and medial rectus recession/resection (RR) surgery for basic exotropia, convergence insufficiency type exotropia (CIXT) and divergence excess (DXS) vs. patients undergoing medial rectus readvancement (MRR) +/- lateral rectus recession for consecutive exotropia. This was a retrospective review from 2009–2022 of 111 patients (84 RR group for basic exotropia (n=52), CIXT (n=9) and DXS (n=23); median age 25 years). The MRR group included 27 with consecutive exotropia with median age of 45 years. For RR and MRR groups, median follow-up was 7 months and 1 month, preoperative median angle at near of 35 prism dioptres (PD) and 40PD, distance angle of 30PD and 37.5PD, median postoperative change in angle at near of -27PD and -34.5PD and for distance of -27PD and -33PD, respectively. Median RR resection was 6mm and recession of 7mm, whilst median MRR readvancement was 5.5mm and recession of 5mm. The postoperative change in angle was significant only for the distance angle. Surgical success rate was not significant between groups although the MRR group had a greater dose effect of PD/mm at near and distance. Further research is needed with longer follow-up periods to determine outcomes over the longer term.

Medial rectus re-advancement: more bang for your buck?
Naderi K, Quah NQX, Adamowicz M, Jain S.
STRABISMUS
2025;33(2):69–74.