Comparison of outcomes of unilateral recession-resection as primary surgery and reoperation for intermittent Exotropia

BACKGROUND: The aim of this study was to compare the primary surgery and reoperation outcomes of unilateral lateral rectus recession and medial rectus resection (R&R) for intermittent exotropia. METHODS: We retrospectively reviewed the medical records of 80 patients, all of whom had undergone unilateral R&R for intermittent exotropia as a primary surgery or reoperation and been followed-up on postoperatively for 6 months or more. The patients were divided into two groups: unilateral R&R as primary surgery (group A, 44 patients) and unilateral R&R as reoperation (group B, 36 patients). The outcome measures were postoperative angle of deviation, surgical success rate, and mean dose-effect ratio (PD/mm, corrected angle of deviation / sum of amount of recession of lateral rectus and of resection of medial rectus). Surgical success was defined as exo- or esodeviation within 8 PD. RESULTS: The mean postoperative follow-up duration was 49.91 ± 14.83 months in group A and 43.17 ± 26.91 months in group B (p = 0.160). The mean angles of deviation at postoperative 1 day were −5.18 PD (overcorrection) in group A and −5.28 PD in group B (p = 0.932). However, there was a significant difference in the mean angle of deviation between the two groups at each visit from postoperative 3 months to final follow-up (p < 0.05): in short, group A had become more exotropic than group B. And the surgical success rate was higher in group B than in group A at each visit from postoperative 12 months to final follow-up (47.7% in group A and 83.3% in group B at final follow-up) (p < 0.05). The mean dose-effect ratio at 6 months after surgery was 1.89 ± 0.58 PD/mm in group A and 2.26 ± 0.32 PD/mm in group B (p = 0.001). CONCLUSIONS: Unilateral R&R as reoperation presented better results for the surgical treatment of recurrent exotropia, showing a smaller exodrift pattern and higher surgical success rates compared with R&R as a primary surgery. The mean effect per millimeter (the mean dose-effect ratio, PD/mm) of R&R as reoperation was significantly greater than that of R&R as primary surgery at postoperative 6 months. These results could serve as useful guidelines in the planning of surgical correction for primary and recurrent exotropia.