Large Bilateral Lateral Rectus Recession in Large Angle Divergence Excess Exotropia

Abstract

Purpose

Classic teaching suggests that surgery for intermittent exotropia should be based on distance/near differences. True divergence excess exotropia should be treated with symmetric lateral rectus recession. The aim of this study was to investigate the effect of large bilateral lateral rectus (LR) recession in large-angle intermittent exotropia.

Methods

Thirty-three consecutive patients with large-angle divergence excess exotropia ranging from 50 to 65 (mean 56.7 ± 6.3) prism diopters were treated with 8.0 to 9.5 mm (mean 8.8 ± 0.7 mm) recession of both LR muscles.

Results

Successful alignment was achieved in 25 cases (76%) while residual exotropia was seen in eight patients (24%) within the limit of 15 prism diopters. Mean follow-up time was 28.5 ± 8.4 (range 13 to 38) months. Abduction deficit due to this procedure was not seen in any case.

Conclusions

We conclude that large bilateral LR recession is an appropriate surgical method for large-angle divergence excess exotropia.

Keywords

Intermittent exotropia Divergence excess exotropia Large-angle exotropia Lateral rectus muscle Large bilateral lateral rectus recession

Get full access to this article

View all access options for this article.

References

Diamond

G.R.

. Exotropia. In: Yanoff

, Duker

J.S.

, ed. Ophthalmology. London: Mosby, 1999; 6, chap 7: 1–4.

von Noorden . Binocular vision and ocular motility: Theory and management of strabismus. St Louis: Mosby, 1996; 341–59.

Hidaji

, Nelson

L.B.

. Exodeviations of childhood. In: Olitsky SE, Nelson LB, ed. Ophthalmol Clin North Am 1996; 9: 185–97.

Frantz

K.A.

. The importance of multiple treatment modalities in a case of divergence excess. J Am Optom Assoc 1990; 61: 451–62.

Kushner

B.J.

. Does overcorrecting minus lens therapy for intermittent exotropia cause myopia? Arch Ophthalmol 1999; 117: 638–42.

Mein

, Trimble

. Diagnosis and management of ocular motility disorders. Oxford: Blackwell Scientific publications, 1991; 227–39.

Stoller

S.H.

, Simon

J.W.

, Lininger

L.L.

. Bilateral lateral rectus recession for exotropia: a survival analysis. J Pediatr Ophthalmol Strabismus 1994; 31: 89–92.

Ing

M.R.

, Nishimura

, Okino

. Outcome study of bilateral rectus recession for intermittent exotropia in children. Trans Am Ophthalmol Soc 1997; 95: 433–43.

Berland

J.E.

, Wilson

M.E.

, Saunders

R.B.

. Results of large (8–9 mm) bilateral lateral rectus muscle recessions for exotropia. Binocul Vis Strabismus Q 1998; 13: 97–104.

10.

Ing

M.R.

, Nishimura

, Okino

. Outcome study of bilateral rectus recession for intermittent exotropia in children. Ophthalmic Surg Lasers 1999; 30: 110–7.

11.

Kushner

B.J.

, Morton

G.V.

. Distance/near differences in intermittent exotropia. Arch Ophthalmol 1998, 116: 478–86.

12.

Pratt-Johnson

J.A.

, Barlow

J.M.

, Tillson

. Early surgery in intermittent exotropia. Am J Ophthalmol 1977; 84: 689–94.

13.

Richards

J.M.

, Parks

M.M.

. lntermittent exotropia: Surgical results in different age groups. Ophthalmology 1983; 90: 1172–7.

14.

Pratt-Johnson , Tillson

. Management of strabismus and amblyopia: A practical guide. New York: Thieme Medical Publishers, 1994: 123–37.

15.

Jampolsky

. Treatment of exodeviations. In: Allen

J.H.

, ed. Pediatric Ophthalmology and Strabismus: Transactions of the New Orleans Academy of Ophthalmology. New York: Raven-Press, 1986; 201–34.

16.

Azar

R.F.

. Surgical management of exotropia exceeding 70 prism diopters. Ann Ophthalmol 1971; 3: 159–68.

17.

Helveston

E.M.

. Surgical management of strabismus. An atlas of strabismus surgery. St Louis: Mosby, 1993; 377–8.

18.

Parks

M.M.

, Mitchell

P.R.

. Concomitant exodeviations. In: Duane

T.D.

, Jaeger

E.A.

, eds. Clinical Ophthalmology. Philadelphia: Harper & Row Publishers, 1986; 1, chap 13: 1–11.

19.

Yang

S.M.

. Large recession of the external rectus for large-angle exotropia. Chung Hua Yen Ko Tsa Chih 1984; 20: 339–41.

20.

Schwartz

R.L.

, Calhoun

J.E.I.

. Surgery of large angle exotropia. J Pediatr Ophthalmol Strabismus 1980; 17: 359–63.

21.

Beneish

, Flanders

. The role of stereopsis and early postoperative alignment in long-term surgical results of intermittent exotropia. Can J Ophthalmol 1994; 29: 119–24.

22.

Keech

R.V.

, Stewart

S.A.

. The surgical overcorrection of intermittent exotropia. J Pediatr Ophthalmol Strabismus 1990; 27: 218–20.

23.

Schlossman

, Muchnick

R.S.

, Stern

. The surgical management of intermittent exotropia in adults. Ophthalmology 1983; 90: 1166–71.

24.

Weinstein

G.S.

, Biglan

A.W.

, Hiles

D.A.

. Postoperative residual small angle exodeviation. Ophthalmic Surg 1982; 13: 478–82.

25.

Scott

W.E.

, Keech

, Mash

A.J.

. The postoperative results and stability of exodeviations. Arch Ophthalmol 1981; 99: 1814–8.