Comparison of bilateral lateral rectus recession and unilateral recession resection for basic type intermittent exotropia in children

Abstract

R&R is more effective than BLR-rec surgery in the long term for the basic type IXT in children.

Clinical Characteristics and Surgical Outcomes in Patients With Intermittent Exotropia

“…In most studies, patients with an obvious vertical deviation, especially DVD, were excluded. 8 , 9 , 22 However, DVD was included in our cohort and revealed another coincident common finding of our patients with a proportion of 4.7%, a rate that was similar to the 4.0% in the study of Jeoung. 23 Similar to that for oblique muscle overaction, surgery for DVD was performed only in patients with vertical deviation more than 10 PD and a frequent occurrence of a remarkable updrift as observed by the patients or their parents.…”

“…BLR is the preferred approach for the divergence excess type, but controversy exists for this basic type. Yang et al 11 reported that BLR showed a better success rate than RR (60.75% vs 43.40%) after an average of 3 years follow-up in study consisting a 50 cases; however, Wang et al 8 stated that RR was more effective than BLR (85.1% vs 65.8% success rate) in a study including 85 patients with the basic type of IXT as determined at a mean follow-up of 14.8 ± 9.5 months. In general, there appears to be no significant difference between these 2 surgical procedures for IXT, 9 which is consistent with our study relating success rates of 36.7% for RR and 37.9% for BLR.…”

Clinical Characteristics and Surgical Outcomes in Patients With Intermittent Exotropia

“…In most studies, patients with an obvious vertical deviation, especially DVD, were excluded. 8 , 9 , 22 However, DVD was included in our cohort and revealed another coincident common finding of our patients with a proportion of 4.7%, a rate that was similar to the 4.0% in the study of Jeoung. 23 Similar to that for oblique muscle overaction, surgery for DVD was performed only in patients with vertical deviation more than 10 PD and a frequent occurrence of a remarkable updrift as observed by the patients or their parents.…”

“…BLR is the preferred approach for the divergence excess type, but controversy exists for this basic type. Yang et al 11 reported that BLR showed a better success rate than RR (60.75% vs 43.40%) after an average of 3 years follow-up in study consisting a 50 cases; however, Wang et al 8 stated that RR was more effective than BLR (85.1% vs 65.8% success rate) in a study including 85 patients with the basic type of IXT as determined at a mean follow-up of 14.8 ± 9.5 months. In general, there appears to be no significant difference between these 2 surgical procedures for IXT, 9 which is consistent with our study relating success rates of 36.7% for RR and 37.9% for BLR.…”

Comparative Study of Unilateral Recession Resection Versus Bilateral Recession in Intermittent Exotropia

“…The results of our study matched with those of Fiorelli and co-workers 16 who found no significant difference between the surgical results of lateral rectus recession and monocular recess resect procedure. Similar results were also reported by Chio and associates, 17 Kim KE et al 18 and Livir Rallatos G. 19 However, Wang L et al 20 reported that for basic type of intermittent exotropia in children, recess-resect surgery had a significantly higher success rate than bilateral lateral rectus recession. The pattern of overcorrection in recessresect group and undercorrection in bilateral recession group was similar to that seen in our study.…”

Effectiveness of treatment approaches for childhood exotropia: a systematic review

“…The studies ( Issaho, Wang & Weakley Jr, 2017 ; Repka et al, 2020a ; Pediatric Eye Disease Investigator Group et al, 2019 ; Wang et al, 2013 ; Spierer & Spierer, 2021 ; Bang, Cho & Lee, 2017 ; Donahue et al, 2024 ; Kushner, 1998 ; Yousef et al, 2025 ; Elkhawaga, Kassem & Elkamshoushy, 2023 ; Huang & Li, 2022 ; Lino, De Aguiar & Cunha, 2025 ) summarized in Tables 3 and 6 collectively confirm that two-muscle surgery remains the primary management option for childhood XT, with bilateral lateral rectus recession (BLRc) and unilateral lateral rectus recession and medial rectus resection (R&R) being the most used techniques. Nevertheless, there is no clear consensus regarding the relative efficacy of these two surgical techniques in terms of postoperative alignment, residual or recurrent of XT, and the risk of consecutive esotropia.…”

Clinical Characteristics and Surgical Outcomes in Patients With Intermittent Exotropia

“…In most studies, patients with an obvious vertical deviation, especially DVD, were excluded. 8 , 9 , 22 However, DVD was included in our cohort and revealed another coincident common finding of our patients with a proportion of 4.7%, a rate that was similar to the 4.0% in the study of Jeoung. 23 Similar to that for oblique muscle overaction, surgery for DVD was performed only in patients with vertical deviation more than 10 PD and a frequent occurrence of a remarkable updrift as observed by the patients or their parents.…”

“…BLR is the preferred approach for the divergence excess type, but controversy exists for this basic type. Yang et al 11 reported that BLR showed a better success rate than RR (60.75% vs 43.40%) after an average of 3 years follow-up in study consisting a 50 cases; however, Wang et al 8 stated that RR was more effective than BLR (85.1% vs 65.8% success rate) in a study including 85 patients with the basic type of IXT as determined at a mean follow-up of 14.8 ± 9.5 months. In general, there appears to be no significant difference between these 2 surgical procedures for IXT, 9 which is consistent with our study relating success rates of 36.7% for RR and 37.9% for BLR.…”

Comparative Study of Unilateral Recession Resection Versus Bilateral Recession in Intermittent Exotropia

“…The results of our study matched with those of Fiorelli and co-workers 16 who found no significant difference between the surgical results of lateral rectus recession and monocular recess resect procedure. Similar results were also reported by Chio and associates, 17 Kim KE et al 18 and Livir Rallatos G. 19 However, Wang L et al 20 reported that for basic type of intermittent exotropia in children, recess-resect surgery had a significantly higher success rate than bilateral lateral rectus recession. The pattern of overcorrection in recessresect group and undercorrection in bilateral recession group was similar to that seen in our study.…”

Effectiveness of treatment approaches for childhood exotropia: a systematic review

“…The studies ( Issaho, Wang & Weakley Jr, 2017 ; Repka et al, 2020a ; Pediatric Eye Disease Investigator Group et al, 2019 ; Wang et al, 2013 ; Spierer & Spierer, 2021 ; Bang, Cho & Lee, 2017 ; Donahue et al, 2024 ; Kushner, 1998 ; Yousef et al, 2025 ; Elkhawaga, Kassem & Elkamshoushy, 2023 ; Huang & Li, 2022 ; Lino, De Aguiar & Cunha, 2025 ) summarized in Tables 3 and 6 collectively confirm that two-muscle surgery remains the primary management option for childhood XT, with bilateral lateral rectus recession (BLRc) and unilateral lateral rectus recession and medial rectus resection (R&R) being the most used techniques. Nevertheless, there is no clear consensus regarding the relative efficacy of these two surgical techniques in terms of postoperative alignment, residual or recurrent of XT, and the risk of consecutive esotropia.…”

Clinical Characteristics and Surgical Outcomes in Patients With Intermittent Exotropia

“…In most studies, patients with an obvious vertical deviation, especially DVD, were excluded. 8 , 9 , 22 However, DVD was included in our cohort and revealed another coincident common finding of our patients with a proportion of 4.7%, a rate that was similar to the 4.0% in the study of Jeoung. 23 Similar to that for oblique muscle overaction, surgery for DVD was performed only in patients with vertical deviation more than 10 PD and a frequent occurrence of a remarkable updrift as observed by the patients or their parents.…”

“…BLR is the preferred approach for the divergence excess type, but controversy exists for this basic type. Yang et al 11 reported that BLR showed a better success rate than RR (60.75% vs 43.40%) after an average of 3 years follow-up in study consisting a 50 cases; however, Wang et al 8 stated that RR was more effective than BLR (85.1% vs 65.8% success rate) in a study including 85 patients with the basic type of IXT as determined at a mean follow-up of 14.8 ± 9.5 months. In general, there appears to be no significant difference between these 2 surgical procedures for IXT, 9 which is consistent with our study relating success rates of 36.7% for RR and 37.9% for BLR.…”

Comparative Study of Unilateral Recession Resection Versus Bilateral Recession in Intermittent Exotropia

“…The results of our study matched with those of Fiorelli and co-workers 16 who found no significant difference between the surgical results of lateral rectus recession and monocular recess resect procedure. Similar results were also reported by Chio and associates, 17 Kim KE et al 18 and Livir Rallatos G. 19 However, Wang L et al 20 reported that for basic type of intermittent exotropia in children, recess-resect surgery had a significantly higher success rate than bilateral lateral rectus recession. The pattern of overcorrection in recessresect group and undercorrection in bilateral recession group was similar to that seen in our study.…”

Effectiveness of treatment approaches for childhood exotropia: a systematic review

“…The studies ( Issaho, Wang & Weakley Jr, 2017 ; Repka et al, 2020a ; Pediatric Eye Disease Investigator Group et al, 2019 ; Wang et al, 2013 ; Spierer & Spierer, 2021 ; Bang, Cho & Lee, 2017 ; Donahue et al, 2024 ; Kushner, 1998 ; Yousef et al, 2025 ; Elkhawaga, Kassem & Elkamshoushy, 2023 ; Huang & Li, 2022 ; Lino, De Aguiar & Cunha, 2025 ) summarized in Tables 3 and 6 collectively confirm that two-muscle surgery remains the primary management option for childhood XT, with bilateral lateral rectus recession (BLRc) and unilateral lateral rectus recession and medial rectus resection (R&R) being the most used techniques. Nevertheless, there is no clear consensus regarding the relative efficacy of these two surgical techniques in terms of postoperative alignment, residual or recurrent of XT, and the risk of consecutive esotropia.…”