Department of Ophthalmology, Inje University Sanggye Paik Hospital, Seoul, Korea.
Am J Ophthalmol. 2012 Feb;153(2):343-351.e1. doi: 10.1016/j.ajo.2011.06.024. Epub 2011 Oct 6.
To conduct a comparison of the long-term surgical outcomes of bilateral lateral rectus recession (BLR) vs unilateral lateral rectus recession-medial rectus resection (RR) in treatment of intermittent exotropia.
Nonrandomized, retrospective case series.
Consecutive patients who underwent BLR or RR for treatment of intermittent exotropia between 2002 and 2006 and had ≥2 years' follow-up were recruited. Surgical outcomes were grouped according to postoperative angle of deviation as overcorrection (esophoria/tropia >5 Δ), success (esophoria/tropia ≤5 Δ to exophoria/tropia ≤10 Δ), or undercorrection/recurrence (exophoria/tropia >10 Δ), and were compared between the BLR group and the RR group at postoperative 1 day, 1 month, 6 months, 1 year, and 2 years, and at the final examination.
Of 128 patients, 55 underwent BLR and 73 underwent RR. The mean follow-up period was 44.2 months in the BLR group and 47.8 months in the RR group. At 1 day, 1 month, 6 months, 1 year, and 2 years after surgery, surgical outcomes in each group were not different (P > .05) However, the final outcome at a mean of 3.8 years was significantly different between the groups, demonstrating a higher success rate in the BLR group than in the RR group (58.2% vs 27.4%, P < .01). Cumulative probability of survival from recurrence was higher in the BLR group than in the RR group (P = .01, log-rank test). Recurrences were most common within 6 months from surgery; however, after that, recurrences occurred continuously in the RR group and rarely in the BLR group.
Surgical outcomes by 2 years after surgery for intermittent exotropia were not different between the BLR and RR groups. However, final outcomes were better in the BLR group than in the RR group. This may be caused by the difference of recurrence rate over time: continuous recurrence of exotropia occurred in the RR group, while recurrence was low in the BLR group after postoperative 6 months.
比较双侧外直肌后退术（BLR）与单侧外直肌后退-内直肌缩短术（RR）治疗间歇性外斜视的长期手术效果。
非随机、回顾性病例系列研究。
连续招募了 2002 年至 2006 年间接受 BLR 或 RR 治疗间歇性外斜视且随访时间≥2 年的患者。根据术后斜视角度将手术结果分为过矫（内斜视/外斜视>5Δ）、成功（内斜视/外斜视≤5Δ至外斜视/内斜视≤10Δ）和欠矫/复发（外斜视/内斜视>10Δ），并在术后 1 天、1 个月、6 个月、1 年和 2 年以及最终检查时比较 BLR 组和 RR 组之间的结果。
128 例患者中，55 例行 BLR，73 例行 RR。BLR 组的平均随访时间为 44.2 个月，RR 组为 47.8 个月。术后 1 天、1 个月、6 个月、1 年和 2 年时，两组的手术结果无差异（P>0.05）。然而，两组的最终结果在平均 3.8 年时差异显著，BLR 组的成功率明显高于 RR 组（58.2%比 27.4%，P<0.01）。BLR 组的复发累积生存率高于 RR 组（P=0.01，对数秩检验）。复发最常见于术后 6 个月内；然而，此后 RR 组持续复发，而 BLR 组很少复发。
间歇性外斜视患者术后 2 年的手术结果在 BLR 和 RR 两组之间无差异。然而，BLR 组的最终结果优于 RR 组。这可能是由于复发率随时间的差异造成的：RR 组持续发生外斜视复发，而 BLR 组在术后 6 个月后复发率较低。
