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

Abstract

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.

Effects of slanted bilateral lateral recession vs conventional bilateral lateral recession on convergence insufficiency intermittent exotropia: a prospective study

“…Their results showed that S-BLR reduced the difference between near and distant deviations, with no obvious complications. Ren et al [23] included 34 patients with CI-IXT and followed up for an average of 15on after S-BLR. Their results showed that the surgical success rate was 70.6%, and the of average near deviation was significantly reduced from preoperative (11.12±2.06) PD to postoperative (2.47±3.04) PD.…”

How to Better Treat Patients with Intermittent Exotropia: A Review of Surgical Treatment of Intermittent Exotropia

“…Surgical treatment of the convergence-insufficiency type X(T) includes RR, modified RR, slanted or nonslanted BLR (upper horn based on distance deviation angle and lower horn based on near deviation angle), slanted or non-slanted uni-/bilateral medial rectus (UMR/BMR) resection with or without an adjustable suture, and medial rectus plication [20,21,24,[67][68][69][70][71][72][73][74][75][76][77][78][79][80][81]. The corresponding success rates ranged from 18 to 92%, and most studies concluded that the duration of consecutive esotropia or diplopia was shorter than 4 weeks, with a tendency to exodrift with time following any of the surgical methods.…”