Comparison of Lateral Rectus Muscle Re-recession and Medial Rectus Muscle Resection for Treatment of Postoperative Exotropia GREGG T. LUEDER AND MARLO GALLI PURPOSE:
To compare the outcomes of unilateral lateral rectus muscle re-recession and medial rectus muscle resection for treatment of recurrent or persistent exotropia. DESIGN: Retrospective nonrandomized clinical trial. METHODS: SETTING: Hospital-based clinical practice. PATIENT POPULATION: Forty patients with recurrent or persistent exotropia following bilateral lateral rectus muscle recessions. INTERVENTION: Fourteen patients were treated with unilateral medial rectus muscle resection and 26 with unilateral lateral rectus muscle rerecession. MAIN OUTCOME MEASURES: Outcomes were considered successful if the patients had deviations less than 10 prism diopters (PD) at last follow-up. All patients were followed for at least 1 year postoperatively. RESULTS: The mean preoperative deviations were 17.4 PD in the medial rectus muscle resection group and 18.1 PD in the lateral rectus muscle re-recession group. Successful outcomes were achieved in 9 of 14 patients (64%) treated with medial rectus muscle resection and 19 of 26 patients (73%) treated with lateral rectus muscle re-recession. There was no statistically significant difference between these outcomes. Mean follow-up was 4.5 years in the medial rectus muscle resection group and 2.9 years in the lateral rectus muscle re-recession group. CONCLUSIONS: Surgery on a single muscle can be used to treat moderate-angle recurrent or persistent exotropia. Unilateral re-recession of the lateral rectus muscle and medial rectus muscle resection have equivalent success rates. (Am J Ophthalmol 2015;159:812–815. Ó 2015 by Elsevier Inc. All rights reserved.)
T
HE NEED FOR REPEAT SURGERY IS COMMON IN
patients with strabismus. Depending on the deviation, different procedures may be considered based on several factors. The misalignment in primary position, the magnitude of the deviation, the presence of other
Accepted for publication Jan 19, 2015. From the Departments of Ophthalmology and Visual Sciences and Pediatrics, St Louis Children’s Hospital, Washington University School of Medicine, St Louis, Missouri. Inquiries to Gregg T. Lueder, St Louis Children’s Hospital (Rm 2s89), Washington University School of Medicine, One Children’s Place, St Louis, MO 63110; e-mail: [email protected]
812
Ó
2015 BY
deviations (vertical, torsional), and the position of the muscles following previous surgery are all important considerations. Recurrent or persistent deviations may develop following surgery for exotropia. If the deviations are moderate, surgery on a single muscle may suffice in order to restore alignment. To our knowledge, results of unilateral re-recession of the lateral rectus muscle have not been previously reported for this condition. In this study, we compared the outcomes of unilateral lateral rectus muscle re-recession and unilateral medial rectus muscle resection for treatment of patients with moderate-angle (
To compare the outcomes of unilateral lateral rectus muscle re-recession and medial rectus muscle resection for treatment of recurrent or persistent exotropia. DESIGN: Retrospective nonrandomized clinical trial. METHODS: SETTING: Hospital-based clinical practice. PATIENT POPULATION: Forty patients with recurrent or persistent exotropia following bilateral lateral rectus muscle recessions. INTERVENTION: Fourteen patients were treated with unilateral medial rectus muscle resection and 26 with unilateral lateral rectus muscle rerecession. MAIN OUTCOME MEASURES: Outcomes were considered successful if the patients had deviations less than 10 prism diopters (PD) at last follow-up. All patients were followed for at least 1 year postoperatively. RESULTS: The mean preoperative deviations were 17.4 PD in the medial rectus muscle resection group and 18.1 PD in the lateral rectus muscle re-recession group. Successful outcomes were achieved in 9 of 14 patients (64%) treated with medial rectus muscle resection and 19 of 26 patients (73%) treated with lateral rectus muscle re-recession. There was no statistically significant difference between these outcomes. Mean follow-up was 4.5 years in the medial rectus muscle resection group and 2.9 years in the lateral rectus muscle re-recession group. CONCLUSIONS: Surgery on a single muscle can be used to treat moderate-angle recurrent or persistent exotropia. Unilateral re-recession of the lateral rectus muscle and medial rectus muscle resection have equivalent success rates. (Am J Ophthalmol 2015;159:812–815. Ó 2015 by Elsevier Inc. All rights reserved.)
T
HE NEED FOR REPEAT SURGERY IS COMMON IN
patients with strabismus. Depending on the deviation, different procedures may be considered based on several factors. The misalignment in primary position, the magnitude of the deviation, the presence of other
Accepted for publication Jan 19, 2015. From the Departments of Ophthalmology and Visual Sciences and Pediatrics, St Louis Children’s Hospital, Washington University School of Medicine, St Louis, Missouri. Inquiries to Gregg T. Lueder, St Louis Children’s Hospital (Rm 2s89), Washington University School of Medicine, One Children’s Place, St Louis, MO 63110; e-mail: [email protected]
812
Ó
2015 BY
deviations (vertical, torsional), and the position of the muscles following previous surgery are all important considerations. Recurrent or persistent deviations may develop following surgery for exotropia. If the deviations are moderate, surgery on a single muscle may suffice in order to restore alignment. To our knowledge, results of unilateral re-recession of the lateral rectus muscle have not been previously reported for this condition. In this study, we compared the outcomes of unilateral lateral rectus muscle re-recession and unilateral medial rectus muscle resection for treatment of patients with moderate-angle (
