Comparative study of plication–recession versus resection–recession in unilateral surgery for intermittent exotropia

• Published in: Japanese journal of ophthalmology Vol. 61; no. 3; pp. 286 - 291
• Main Authors: Kimura, Yugo, Kimura, Tohru
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.05.2017; Springer Nature B.V
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Clinical Investigation; Exotropia - physiopathology; Exotropia - surgery; Eye Movements - physiology; Female; Follow-Up Studies; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Oculomotor Muscles - physiopathology; Oculomotor Muscles - surgery; Ophthalmologic Surgical Procedures - methods; Ophthalmology; Recurrence; Retrospective Studies; Time Factors; Treatment Outcome; Vision, Binocular - physiology; Visual Acuity; Young Adult; Plication; Resection; Recession; Exotropia; Surgery
• ISSN: 0021-5155; 1613-2246
• DOI: 10.1007/s10384-017-0501-5

Purpose Plication is a muscle-strengthening procedure in which a muscle is not dissected from its point of insertion. The purpose of this study was to compare the results of plication–recession (PR) with those of resection–recession (RR) in adult patients with intermittent exotropia (XT). Methods Patients with XT who underwent either PR or RR with a minimum postoperative follow-up of 12 months were retrospectively reviewed. Postoperative mean distance deviation and surgical outcomes were compared at 1 week and at 1, 3, 6, and 12 months, and at the final follow-up. A successful outcome was defined as esophoria or esotropia ≤5 PD (prism diopters) to exophoria or exotropia ≤10 PD. Results Forty-five patients underwent PR and 43 underwent RR. The mean preoperative distance deviation was 40.1 ± 12.9 PD in the PR group and 40.0 ± 14.9 PD in the RR group (P = 0.96). Mean follow-up was 21.0 ± 7.6 months for PR and 24.0 ± 8.6 months for RR (P = 0.08). The mean postoperative distance deviation at 12 months was 8.3 ± 7.4 PD for PR and 9.9 ± 9.6 PD for RR (P = 0.38). PR had a significantly better outcome than RR at 1 week (PR 89%; RR 72%; P = 0.04), but there was no difference between PR and RR at 12 months (PR 67%; RR 60%; P = 0.50). Conclusion PR and RR achieved comparable distance deviation and success rates at 12 months. PR had a better short-term success rate, and might prevent postoperative diplopia caused by overcorrection.