Long-term Results of Slanted Recession of Bilateral Lateral Rectus Muscle for Intermittent Exotropia with Convergence Insufficiency

Kwon, Ji Min; Lee, Soo Jung

doi:10.3341/kjo.2019.0031

Cited by 10 publications

(16 citation statements)

References 22 publications

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“…It was reported that this procedure was superior in reducing both distance and near deviations and in reducing the distance-near deviation difference. In two other studies performed by Kwon et al [14] and Farid et al [15], this procedure was also proved to be safe and efficient in reducing the distance and near deviation and also the distance-near difference of deviation. However, further studies are still needed.…”

Section: Introductionmentioning

confidence: 74%

“…At 6 months postoperatively, none of the children demonstrated abduction limitation, diplopia, consecutive esotropia, torsion, or A-V pattern misalignment. In Kwon and Lee's study[14], 53 patients with CI-IXT underwent SLR-rec with a follow-up of more than 12 months. At the last follow up, surgical success rate was 58.5%, and a distance-near deviation difference ≤ 8 PD was measured in 81.1% of patients, which also confirmed the efficiency of SBLR in reducing the distancenear deviation difference.…”

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confidence: 99%

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Slanted bilateral lateral rectus recession for convergence insufficiency-type intermittent exotropia: a retrospective study

Ren

Wang

2020

Preprint

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Background The present study sought to investigate the efficiency and safety of SBLR-rec for the treatment of CI-IXT.Methods This retrospective case series study included 34 patients who underwent SBLR-rec for CI-IXT in Shandong Provincial Hospital affiliated to Shandong University between September 2013 and October 2015 with a minimum follow-up of 6 months. A successful surgical alignment was defined as +5 to -10 prism diopters (PD) of orthophoria in the primary position while viewing distant or near targets and a difference between the distance and near deviation angles of ≤8PD.Results The mean age of the patients at surgery was 7.09±3.80 years (range, 3 to 18 years). The mean distance deviations were -26.09±6.5 PD (range, -15 to -35 PD) and the mean near deviations, -37.21±6.3 PD (range, -25 to -45 PD) preoperatively. The mean recession amount of upper pole of the lateral rectus was 5.97 mm (range, 4.0 to 7.5mm) and that of lower pole of the lateral rectus, 7.49 mm (range, 6.0 to 8.5mm). At a mean follow-up of 15.0 months (range, 6 to 37 months), the surgical success rate was 70.6% (24/34), the under-correction rate was 17.6% (6/34), and the overcorrection rate was 11.8% (4/34). The mean difference between the distance and near deviation angles was significantly reduced from 11.12±2.06 PD (range, 10 to 15 PD) preoperatively to 2.47±3.04 PD (range, 0 to 10 PD) postoperatively (P<0.001). Each millimeter of difference between the upper and lower poles of the lateral rectus recession was associated with an improvement of 5.65 PD in the near-distance difference of deviation. At the final follow up, a distance-near difference of deviation of ≤8PD was found in 32 (94.1%) patients. none of the patients developed A-V pattern, torsional diplopia, or restricted abduction of the eyes.Conclusions SBLR-rec for CI-IXT may successfully reduce the distance and near exodeviations and the distance-near deviation difference, thus was proved to be an effective and safe procedure for the treatment of CI-IXT.

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Section: Introductionmentioning

confidence: 74%

mentioning

confidence: 99%

Slanted bilateral lateral rectus recession for convergence insufficiency-type intermittent exotropia: a retrospective study

Ren

Wang

2020

Preprint

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“…In another study including 31 children with CI-IXT conducted by Chun and Kang [2], the success rate was reported to be 83.9%. And in Kwon and Lee's study [14] in which 53 patients with CI-IXT underwent SBLR-rec with a follow-up of more than 12 months, the surgical success rate was 58.5%. Farid and Abdelbaset [15] compared the three surgical procedures for treatment of CI-IXT, which were, slanted bilateral LR recession(S-BLR), the improved unilateral MR resection-LR recession in which the resection were based on the near deviation and the recession on distance deviation, and augmented bilateral LR recession (A-BLR) in which the recession was based on the near deviation.…”

Section: Discussionmentioning

confidence: 92%

“…However, Farid and Abdelbaset [15] compared SBLR-rec with two other surgical procedures and reported no significant differences among the three groups in the success rates of distance exodeviation, near exodeviation, and N-D deviation difference after 1 year. Moreover, they reported cases of asymptomatic vertical pattern strabismus after SBLR-rec procedure, while the other studies [1,2,14] didn't report similar findings. In the present study, we retrospectively analyzed the surgical results of 34 patients who underwent SBLR-rec for CI-IXT with a minimum follow-up of 6 months.…”

Section: Introductionmentioning

confidence: 92%

“…Surgical management is required for patients that show little effect of non-surgical measures or for patients whose deviations are too large or poorly controlled [3]. The various surgical procedures for CI-IXT include unilateral or bilateral medial rectus (MR) resection(s), bilateral lateral rectus (LR) recessions, unilateral LR recession combined with MR resection [4][5][6][7], MR resection with adjustable sutures [3], slanted bilateral MR resections [8][9][10], improved unilateral LR recession combined with MR resection [11][12][13], and slanted bilateral lateral rectus recession (SBLR-rec) [1,2,14,15]. The reported success rates range from 13.3 to 92%.…”

Section: Introductionmentioning

confidence: 99%

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Slanted bilateral lateral rectus recession for convergence insufficiency-type intermittent exotropia: a retrospective study

Ren

Wang

2020

BMC Ophthalmol

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Background: The present study sought to investigate the efficiency and safety of slanted bilateral lateral rectus recession for the treatment of convergence insufficiency-type intermittent exotropia. Methods: This retrospective study included 34 patients who underwent slanted bilateral lateral rectus recession for convergence insufficiency-type intermittent exotropia in Shandong Provincial Hospital affiliated to Shandong First Medical University between September 2013 and October 2015 with a minimum follow-up of 6 months. A successful surgical alignment was defined as + 5 (positive for esotropia) to − 10 (negative for exotropia) prism diopters (PD) of orthotropia in the primary position while viewing distant or near targets and a near-distance deviation difference ≤ 8PD. Results: The mean age of the patients at surgery was 7.09 ± 3.80 years (range, 3 to 18 years). The mean distance deviations were − 26.09 ± 6.5 PD (range, − 15 to − 35 PD) and the mean near deviations, − 37.21 ± 6.3 PD (range, − 25 to − 45 PD) preoperatively. The mean recession amount of upper pole of the lateral rectus was 5.97 mm (range, 4.0 to 7.5 mm) and that of lower pole of the lateral rectus, 7.49 mm (range, 6.0 to 8.5 mm). At a mean follow-up of 15.0 months (range, 6 to 37 months), the surgical success rate was 70.6% (24/34), the under-correction rate was 17.6% (6/34), and the overcorrection rate was 11.8% (4/34). The mean near-distance deviation difference was significantly reduced from 11.12 ± 2.06 PD (range, 10 to 15 PD) preoperatively to 2.47 ± 3.04 PD (range, 0 to 10 PD) postoperatively (P < 0.001). Each millimeter of difference between the upper and lower poles of the lateral rectus recession was associated with an improvement of 5.65 PD in the near-distance deviation difference. At the final follow up, a near-distance deviation difference of ≤8PD was found in 32 (94.1%) patients. None of the patients developed A-V pattern, torsional diplopia, or restricted abduction of the eyes. Conclusions: Slanted bilateral lateral rectus recession may successfully reduce the distance and near exodeviations and the near-distance deviation difference, thus was proved to be an effective and safe procedure for the treatment of convergence insufficiency-type intermittent exotropia.

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Comparison of surgical outcomes of slanted procedure for exotropia with convergence insufficiency according to their response to preoperative monocular occlusion

Chun

Choi

2020

Sci Rep

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The aim of this prospective study was to compare surgical outcomes of slanted bilateral lateral rectus (LR) recession for intermittent exotropia (IXT) with convergence insufficiency (CI) according to their response to preoperative monocular occlusion. This prospective study included 55 children who underwent slanted bilateral LR recession for IXT with CI. Patients were divided into two groups according to their response to preoperative monocular occlusion for 2 hours. The True CI group was defined as having near-distance differences of ≥10 PD before and after occlusion; the Masked CI group as having near-distance differences of <10 PD and ≥10 PD prior to and after occlusion. Slanted procedure reduced distance and near exodeviations from 32.1 PD and 43.0 PD to 3.5 PD and 4.4 PD, and collapsed near-distance differences from 10.9 PD to 1.0 PD at 3 years postoperatively. Cumulative probabilities of surgical success were 76%, and the mean recurrence was 50 months at 3 years postoperatively; the True CI and Masked CI groups showed cumulative success rates of 89% and 55%, respectively (p = 0.0052). Patients in the True CI group demonstrated surgical outcomes superior to those demonstrated by patients in the Masked CI group after slanted bilateral LR recession. Intermittent exotropia (IXT) with convergence insufficiency (CI) is defined as having a greater exodeviation at near than at distance by ≥10 prism diopters (PD), which occurs in only 1.2-7.8% of IXT cases 1-4. The etiology of IXT with CI remains unclear, but it may be associated with a weak fusional convergence, a low accommodative convergence to accommodation (AC/A) ratio, tenacious distant fusional drive, or reduced accommodative amplitudes 1,5. Nonsurgical treatments can relieve symptoms related to IXT with CI, including headache, diplopia, blurred vision, and reading problems 5,6. However, strabismus surgery is often required to prevent loss of binocular vision in patients who do not respond to nonsurgical treatments, or have a considerably large exodeviation 6-8. Various surgical procedures for IXT with CI have been introduced in addition to the conventional recession or resection, including the use of adjustable sutures, slanted lateral rectus (LR) recession, slanted medial rectus (MR) resection, and unilateral surgery biased toward MR strengthening than toward LR weakening 1,5,7-16. However, most of the procedures resulted in unsatisfactory success rates between 18% and 67%, and some patients often experienced limitation of abduction or postoperative diplopia 10,12,17,18. Snir et al. 1 introduced slanted LR recession, which demonstrated the best success rate of 92% in 12 patients until 12 months after surgery. This surgical technique recesses the lower fibers of the LR muscle more than the upper fibers; thus, it improves postoperative alignments and collapses near-distance differences in IXT with CI 1. However, most patients in their study were adults, and other studies on slanted LR recession had a small sample size and short follow-up periods 15,16. Addit...

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Long-term Results of Slanted Recession of Bilateral Lateral Rectus Muscle for Intermittent Exotropia with Convergence Insufficiency

Cited by 10 publications

References 22 publications

Slanted bilateral lateral rectus recession for convergence insufficiency-type intermittent exotropia: a retrospective study

Slanted bilateral lateral rectus recession for convergence insufficiency-type intermittent exotropia: a retrospective study

Slanted bilateral lateral rectus recession for convergence insufficiency-type intermittent exotropia: a retrospective study

Comparison of surgical outcomes of slanted procedure for exotropia with convergence insufficiency according to their response to preoperative monocular occlusion

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