Study: Medial Rectus Resection Most Reliable Surgical Option for Intermittent Exotropia

Bilateral lateral rectus recession (BLR), unilateral recession-resection (RR) and medial rectus resection (MRR) were all effective surgical approaches for intermittent exotropia due to convergence insufficiency, with BLR favoring distance correction, RR showing short-term near benefits and MRR demonstrating balanced long-term outcomes, including improvement in the AC/A ratio. Photo: B. Navez/Wikicommons. Click image to enlarge. A recent study published in The Open Ophthalmology Journal compared three surgical approaches for convergence insufficiency intermittent exotropia (IXT) in children to identify the most effective method:Bilateral lateral rectus recession (BLR)Unilateral recession-resection (RR)Medial rectus resection (MRR)Researchers from Saudi Arabia and Egypt found that MRR is the most effective and reliable surgical option for IXT, providing balanced outcomes and favorable improvements in the AC/A ratio with a low incidence of complications. A total of 58 children between ages four and 13 with IXT and near-distance disparity ≥10 prism diopters (PD). Surgical outcomes were defined as postoperative deviation within 5PD of esophoria/tropia and 10PD of exophoria/tropia. Patients were followed for 24 months.At 12 months, there was no statistically significant difference in the cumulative success rates for near fixation, distance fixation or near-distance disparity (NDD) among the three groups.MRR appeared to be the most reliable overall, demonstrating the most consistent long-term results, maintained balanced outcomes and provided the only significant improvement in the AC/A ratio. These results align with those reported in a previous study that introduced an improved version of the unilateral recession-resection procedure tailored to treat IXT and reported similar successes in near and distant exodeviation corrections.BLR was effective for distance correction, with a success rate of 77.1% at 12 months, but was associated with a higher incidence of postoperative overcorrection and A-V patterns.The RR group showed more moderate results, with a success rate of 43.4% for distant exodeviation correction at 12 months. The RR technique exhibited a higher rate of undercorrection (56.5%) at 12 months. Despite this, the RR group demonstrated a significant improvement in near exodeviation correction at three months (69.5%), although this improvement diminished over time (30.4% at 12 months). “This suggests that RR may offer more short-term benefits in correcting near deviation, though its long-term effectiveness in correcting both near and distant exodeviations may be less robust,” the authors wrote in their paper.At the final follow-up, cumulative success rates were similar among BLR (52.4% near, 81% at distance), RR (30.4% near, 43.5% at distance) and MRR (27.3% near, 50% at distance). Near exodeviation decreased significantly in all groups. NDD correction was achieved in 59.1% of MRR, 50% of BLR and 30.4% of RR patients. Stereopsis improved comparably across groups.Regarding NDD, the MRR group had the highest cumulative probability of success in reducing NDD at 12 months (59%), followed by the BLR group (50%) and the RR group (30.4%). However, the difference between the groups was not statistically significant, suggesting that all three surgical techniques have comparable efficacy in addressing NDD. These findings are consistent with previous studies that showed similar success rates among different surgical approaches for correcting NDD. Although MRR showed a trend toward greater success in achieving this outcome, the authors noted that the differences were not clinically significant.None of the surgical approaches caused permanent post-op diplopia or persistent overcorrection at near fixation. Complications, such as consecutive esotropia and A-V patterns, were managed effectively with adjunctive measures, including cycloplegic correction, full-time patching and the use of Fresnel prisms.Click here for the journal source. Swelam A, Ghaith K, Elsayed A, et al. Comparative analysis of three surgical approaches for managing convergence insufficiency intermittent exotropia in pediatric patients. Open Ophthalmol J. September 24, 2025. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.