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Ophthalmology. 2019 Feb;126(2):305-317. doi: 10.1016/j.ophtha.2018.08.034. Epub 2018 Sep 3.

A Randomized Trial Comparing Bilateral Lateral Rectus Recession versus Unilateral Recess and Resect for Basic-Type Intermittent Exotropia.

Author information

1
Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: pedig.@jaeb.org.
2
Jaeb Center for Health Research, Tampa, Florida.
3
Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.
4
Department of Ophthalmology, Queen's University, Kingston, Ontario, Canada.
5
Section of Ophthalmology, Texas Children's Hospital, Houston, Texas.
6
Department of Ophthalmology, Indiana University, Indianapolis, Indiana.
7
Rocky Mountain Eye Care Associates, Salt Lake City, Utah.
8
Houston Eye Associates, Houston, Texas.

Abstract

PURPOSE:

To compare long-term outcomes after bilateral lateral rectus recession (BLRc) or unilateral lateral rectus recession combined with medial rectus resection in the same eye (R&R) for primary treatment of childhood intermittent exotropia (IXT).

DESIGN:

Multicenter, randomized clinical trial.

PARTICIPANTS:

One hundred ninety-seven children 3 to younger than 11 years of age with basic-type IXT, a largest deviation by prism and alternate cover test at any distance of 15 to 40 prism diopters (PD), and near stereoacuity of at least 400 seconds of arc.

METHODS:

Random assignment to BLRc or R&R and masked examinations conducted every 6 months after surgery for 3 years.

MAIN OUTCOME MEASURES:

Proportion of participants meeting suboptimal surgical outcome by 3 years, defined as: (1) exotropia of 10 PD or more at distance or near using simultaneous prism and cover test (SPCT); or (2) constant esotropia of 6 PD or more at distance or near using SPCT; (3) loss of 2 octaves or more of stereoacuity from baseline, at any masked examination; or (4) reoperation without meeting any of these criteria.

RESULTS:

Cumulative probability of suboptimal surgical outcome by 3 years was 46% (43/101) in the BLRc group versus 37% (33/96) in the R&R group (treatment group difference of BLRc minus R&R, 9%; 95% confidence interval [CI], -6% to 23%). Reoperation by 3 years occurred in 9 participants (10%) in the BLRc group (8 of 9 met suboptimal surgical outcome criteria) and in 4 participants (5%) in the R&R group (3 of 4 met suboptimal surgical outcome criteria; treatment group difference of BLRc minus R&R, 5%; 95% CI, -2% to 13%). Among participants completing the 3-year visit, 29% (25 of 86) in the BLRc group and 17% (13 of 77) in the R&R group underwent reoperation or met suboptimal surgical outcome criteria at 3 years (treatment group difference of BLRc minus R&R, 12%; 95% CI, -1% to 25%).

CONCLUSIONS:

We did not find a statistically significant difference in suboptimal surgical outcome by 3 years between children with IXT treated with BLRc compared with those treated with R&R. Based on these findings, we are unable to recommend one surgical approach over the other for childhood IXT.

PMID:
30189281
PMCID:
PMC6348023
[Available on 2020-02-01]
DOI:
10.1016/j.ophtha.2018.08.034

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