The efficacy of bilateral inferior oblique (BIO) myectomy vs BIO recession, in combination with bilateral rectus (BLR) recession, in children with V-pattern exotropia has not been well studied.
Study Design
This was a retrospective review of records from 50 pediatric patients who underwent BLR recession with either BIO myectomy or BIO recession for V-pattern exotropia with bilateral inferior oblique overaction (IOOA). Outcomes were final horizontal and vertical deviations, residual V pattern, control of residual horizontal deviation, and residual IOOA.
Outcomes
Both BIO myectomy and BIO recession, in conjunction with BLR recession, decreased the exotropia. However, myectomy had a greater effect on decreasing the V pattern and inferior oblique overaction, particularly in patients who had ≥15Δ of vertical incomitance at baseline. In addition, patients undergoing myectomy demonstrated better control of residual horizontal strabismus than patients undergoing BIO recession.
Limitations
This was a retrospective review, but the decision to use BIO myectomy vs BIO recession was based on surgeon practice and not patient characteristics. Two surgeons employed myectomy while 6 surgeons employed recession.
Clinical Significance
When coupled with BLR recession, BIO myectomy had a greater effect than BIO recession on decreasing the V-pattern, decreasing residual IOOA overaction, and improving residual strabismus control in patients with V-pattern exotropia. Further studies with larger populations may be needed to confirm these findings.
Financial Disclosures: Dr. Laura Enyedi discloses financial relationships with Cooper Vision, Novartis (Consultant/Advisor), Ocular Therapeutix (Grant Support), Sophia Pharma (Lecture Fees/Speakers Bureau), and Wolters Kluwer Health (Patents/Royalty).