Comparison of Supramaximal Recession and Disinsertion/Extirpation of the Lateral Rectus Muscle for Treatment of Large Angle or Recurrent Exotropia
Marlo Galli, CO; Zisansha Zahirsha; Gregg Lueder, MD
Washington University Department of Ophthalmology
Saint Louis, Missouri
Introduction: To compare surgical results of supramaximal lateral rectus recessions (SMRc) and LR disinsertion and extirpation (D&E) for the treatment of large-angle or recurrent exotropia.
Methods: Retrospective review of 12 patients treated with either lateral rectus SMRc (6 patients) or D&E (6 patients). One patient underwent bilateral SMRc and 3 patients underwent bilateral D&E .
Results: The average SMRc was 12 mm from the original insertion. Mean preoperative exotropia was 36 PD (range 18-50 PD) in the SMRc patients and 48 PD (range 10-80 PD) in the D&E patients. Mean postoperative deviation was 22 PD (range 0-50 PD) in the SMRc patients and 28 PD (range 14-60 PD) in the D&E patients. One patient in each group developed consecutive esotropia. The average change in abduction was -0.57 after SMRc and -0.75 after D&E. Postoperative follow-up averaged 2.6 years (range 2 mos-13 years).
Discussion: Supramaximal LR recessions and complete disinsertion and extirpation of the muscle had surprisingly modest effects on postoperative abduction and the risk of consecutive esotropia was small.
Conclusion: The study provides support for the use of SMRc and D&E of the lateral rectus muscle for treatment of large angle and recurrent exotropia. We found similar outcomes for these procedures.
References: 1.Berland JE, Wilson ME, Saunders RB. Results of large (8-9 mm) bilateral lateral rectus muscle recessions for exotropia. Binocular Vision & Strabismus Quarterly. 1998;13(2):97-104.
2.Schwartz RL, Calhoun JH. Surgery of large angle exotropia. Journal of Pediatric Ophthalmology and Strabismus. 1980;17(6):359-363.