Motor alignment and sensory outcomes in pediatric patients with basic-type intermittent exotropia after bilateral lateral rectus recession versus unilateral recession-resection.

Abstract

Purpose: To compare motor alignment and sensory outcomes after bilateral lateral rectus recession (BLR) versus unilateral lateral rectus recession with medial rectus resection (R&R) in children with basic-type intermittent exotropia (IXT).

Methods: This retrospective cohort study included 48 patients with basic-type IXT who underwent BLR (n = 26) or unilateral R&R (n = 22). Assessments were performed preoperatively and at 1 month and 1 year postoperatively. Deviation angles were measured in prism diopters (PD). Near stereopsis was analyzed after log transformation, and sensory status was evaluated using the Worth 4-dot test. The primary outcome was 1-year motor success, defined as a residual deviation ≤ 10 PD.

Results: Baseline characteristics were similar between groups (all p > 0.05). Motor success rates were comparable between BLR and R&R at 1 month (92% vs. 91%; p = 1.000) and 1 year (88% vs. 86%; p = 1.000). Orthophoria rates (77% vs. 68%; p = 0.497) and reoperation rates (12% vs. 14%; p = 0.827) were also similar. Deviation decreased significantly over time (p < 0.001). Stereopsis improved postoperatively and was maintained at 1 year (p < 0.001). In an exploratory multivariable analysis, higher preoperative deviation was associated with lower odds of motor success (aOR 0.71; p = 0.024); however, this estimate should be interpreted cautiously because of the limited number of failure events.

Conclusions: BLR and unilateral R&R yielded comparable motor and sensory outcomes at 1 year postoperatively in basic-type IXT. The exploratory association between higher preoperative deviation and lower motor success requires confirmation in larger cohorts.