Department of Ophthalmology, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Anyang, South Korea.
Department of Ophthalmology, Hallym University College of Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, South Korea.
PLoS One. 2019 Aug 19;14(8):e0221268. doi: 10.1371/journal.pone.0221268. eCollection 2019.
Most ophthalmologists appear to have no distinct preference between unilateral recess-resect (R&R) and bilateral lateral rectus (BLR) recessions to treat basic-type exotropia. This study aimed to determine whether differences in distance-near discrepancy and resultant exotropia types of recurrent exotropia following surgery for primary basic-type exotropia exist between the two surgical options.
Ninety-three patients with recurrent exotropia following BLR recessions for basic-type exotropia (BLR group) and 95 following R&R for basic-type exotropia (R&R group) were included in this retrospective study. The exotropia types in recurrent exotropia were classified into three types according to distance-near discrepancy: basic, divergence-excess, and convergence-insufficiency. The BLR and R&R groups were compared.
After surgery for basic-type exotropia, the type composition changed differently in each group (p < 0.001). The basic-type of primary exotropia was more often maintained in recurrent exotropia in the R&R group than in the BLR group. The incidence of postoperative convergence-insufficiency type exotropia in the BLR group was 28.0% and 8.4% in the R&R group (p = 0.001). Postoperative near stereopsis and fusion control grade of distance deviation did not differ between the two groups (p > 0.05).
Convergence-insufficiency type recurrent exotropia occurred more frequently after BLR recessions than after R&R for basic-type exotropia. The high rate of secondary convergence-insufficiency type exotropia after BLR recessions should be considered when clinicians select a surgical option to treat exotropia.
大多数眼科医生似乎对单侧后退-切除（R&R）和双侧外直肌后退（BLR）后退治疗基本型外斜视没有明显的偏好。本研究旨在确定在治疗原发性基本型外斜视的两种手术选择中，术后距离-近距差异和复发性外斜视的结果外斜视类型是否存在差异。
本回顾性研究纳入了 93 例因基本型外斜视行 BLR 后退术（BLR 组）和 95 例行 R&R 治疗基本型外斜视（R&R 组）后发生复发性外斜视的患者。根据距离-近距差异将复发性外斜视的外斜视类型分为三种：基本型、分离过强型和集合不足型。比较 BLR 组和 R&R 组。
在治疗基本型外斜视后，每组的类型构成均发生了不同的变化（p < 0.001）。在 R&R 组中，基本型原发性外斜视在复发性外斜视中更常被保留，而在 BLR 组中则不然。BLR 组术后出现集合不足型外斜视的发生率为 28.0%，R&R 组为 8.4%（p = 0.001）。两组术后近立体视和融合控制等级对距离偏差无差异（p > 0.05）。
与 R&R 治疗基本型外斜视相比，BLR 后退术治疗基本型外斜视后更常发生集合不足型复发性外斜视。在选择治疗外斜视的手术方案时，应考虑 BLR 后退术会导致继发性集合不足型外斜视的高发生率。
