A modified swan incision combined with lateral rectus suspension for exotropia: a retrospective cohort study demonstrating shorter operative time and faster recovery.

Background: A modified Swan incision (MSI) combined with lateral rectus muscle suspension surgery represents an innovative strabismus surgical technique developed by our research team. Compared to the conventional Swan incision, the MSI features a 50% reduction in length with more posterior placement. The suspension technique is a modified recession approach that corrects strabismus by creating a hammock-like structure to reposition the muscle at new insertion site, rather than directly suturing the muscle to the sclera. This study aims to evaluate the safety, efficacy, and potential advantages of this MSI technique for exotropia.

Methods: A retrospective cohort study was conducted on 66 patients with exotropia treated from January 2024 to December 2024. The patients were divided into two groups based on actual surgical procedures: the MSI group (33 patients, 42 eyes) and the control group (33 patients, 36 eyes). The MSI group underwent the MSI technique, while the control group underwent traditional Parks incision combined with lateral rectus recession. The surgical time, postoperative recovery, and correction outcomes were compared between the two groups.

Results: The MSI group showed significantly shorter surgical time (P < 0.0001) and lower redness score at 1 week postoperatively (P < 0.001), with comparable surgical success rate to control group (P > 0.9999).

Conclusion: The MSI combined with lateral rectus suspension surgery demonstrates both efficacy in ocular alignment correction and favorable safety in surgery. This technique significantly shortens surgical time, reduces tissue damage, improves postoperative recovery, making it a valuable option for widespread application.