Traditional and reduced recession surgical dosage for bilateral lateral rectus recession for infantile exotropia

Background: To investigate the optimal surgical dose for treating infantile exotropia.

Methods: In this retrospective study, clinical records of 44 children who had undergone bilateral lateral rectus recessions before 4 years of age for an exotropia present before 12 months of age were studied. Children had 1 year of follow-up after surgery. Patients were separated into those who had traditional surgery and those who received a reduced recession of their lateral recti.

Results: The traditional surgery group comprised 36% of the patients and the reduced recession group, 1-2 mm reduction in the recession, comprised 64% of the study group. There was borderline significance (p=0.074) when the postoperative angle of deviation was compared in the early postoperative period. The traditional group had a mean deviation of 5.25 prism dioptres (PD) of esodeviation compared with the reduced recession group having a 2.91 esodeviation. There was no statistical difference at the 1-year evaluation of the alignment. The traditional group had a mean exodeviation of 2.63 PD compared with the reduced recession group having a 2.91 PD exodeviation.

Conclusions: Postoperative surgical outcome was not affected by a reduction in the amount of recession by 1-2 mm from traditional tables used for treatment of exotropia. Reducing the recession of the lateral recti reduces the risk of overcorrection in this sensory labile population.