The Comparision of Outcomes Between Lateral Rectus Muscles Re-recession and Medial Rectus Muscles Resection in Recurrent Exotropia

Abstract

PurposeTo compare the surgical outcomes between bilateral lateral rectus muscles (BLR) re-recession and bilateral medial rectus muscles (BMR) resection in recurrent exotropia.MethodsThe medical records of patients with recurrent exotropia who underwent surgery for intermittent exotropia during the 6 years from January 2001 to December 2006 and followed up for more than 6 months were reviewed retrospectively.ResultsIn group A, BLR recessions was performed at the first surgery and BLR re-recession was performed at the second surgery. In group B, BLR recession was performed at the first surgery and BMR resection at the second surgery. Success rates at the last follow-up after the second operation were 81.9% in Group A and 83.3% in Group B, showing no statical difference between the two groups. In group A, no significant underaction of the BLR was noted. Success rates were not statistically different between the 2 mm re-recessed subgroup and 3 mm re-recessed subgroup.ConclusionsThe results support the notion that BLR re-recession successfully corrects recurrent exotropia without producing significant limitation of abduction.

Surgical Outcome of Medial Rectus Resection in Recurrent Exotropia: A Novel Surgical Formula

“…In Asian patients, Yam et al [ 6 ] reported success rate of 51% for intermittent exotropia after bilateral LR recession at 3 years in a Chinese population, whereby Choi et al [ 2 ] reported a success rate of 58% at a comparable 3.8-year follow-up in a Korean population. Furthermore, variable success rates have also been reported in the limited studies on reoperation for recurrent exotropia ranging from 66 to 83% [ 3 , 5 ], with recurrence rates after reoperation reported to be 33% by 18 months and 60% by 51 months [ 10 ]. However, the success rate of these studies may not be directly comparable due to differences in preoperative angle deviation and surgical technique.…”

“…There is currently no normogram in literature to determine the surgical dosage for patients with recurrent exotropia. Several studies report variable MR muscle resection correction ranging from of 2 to 6.7 PD per mm [ 3 , 11 – 13 ], but no easily reproducible or predictive surgical formula has yet been proposed. Herein, we report an easy approach using our surgical formula of MR muscle resection for recurrent exotropia, which can help simplify the calculation of the amount of MR muscle to be resected.…”

“…Debate still exists as to whether LR muscle rerecession or medial rectus (MR) muscle resection would be the most optimal treatment. Some advocate that LR muscle rerecession can help conserve the unoperated MR muscles and has comparable surgical outcomes with MR resection [ 3 ]. The advantage of graded resection surgery is that the surgeon can work with muscles not previously operated on, which is a technically easier procedure with clearer surgical landmarks.…”

“…However, deduction of optimal MR muscle resection for recurrent exotropia after two-muscle surgery remains controversial, as current surgical dosage tables [ 4 ] for muscle resection calculations are suggested for primary operation, with unpredictability in outcomes for reoperations. Variable results are reported in bilateral MR muscle resection for recurrent exotropia despite similar surgical dosages adopted using these surgical tables, with success rates ranging from 54% to 83% [ 3 , 5 ]. As recurrent exotropia is commonly seen after primary operation for intermittent exotropia [ 6 ], a surgical formula for reproducing predictable results in reoperations would be beneficial.…”

Silicone Band in the Surgical Treatment of Manifest Exotropia

“…The relapse management consist in surgery [16] in-volving lateral rectus or medial rectus (unless previously treated) [17,18]. According to several studies, relapse occurs in about 33% of cases and it might happen even following redo surgery (although with a lower probability compared with the first surgery [6,19,20]).…”