Surgical options appear comparable for intermittent childhood exotropia

In this large multicenter randomized trial, investigators evaluated the long-term outcomes of 2 surgical approaches for managing childhood intermittent exotropia (IXT): bilateral lateral muscle recession and unilateral recess-resect.

Study design

This clinical trial was conducted by the Pediatric Eye Disease Investigator Group (PEDIG) at various academic- and community-based clinical sites. Researchers randomly assigned 197 children with basic type IXT between the ages of 3 to 11 years to either bilateral lateral rectus recession (BLRc) or unilateral recess-resect (R&R). Masked twice-yearly examinations were conducted over 3 years.

A suboptimal surgical outcome was defined as meeting any of the 4 criteria during follow-up: exotropia (≥10∆) at distance or near, constant esotropia (≥6∆) at distance or near, loss of 2 octaves or more of stereoacuity from baseline or reoperation without meeting any of these criteria.

Outcomes

The cumulative probability of a suboptimal surgical outcome through 3 years of follow up was 46% in the BLRc group and 37% in the R&R group. Reoperation rates were 10% and 5% in the BLRc and R&R groups, respectively. These differences did not reach statistical significance.

Lead investigator Dr. Sean Donahue discusses outcomes from this study in this interview from AAO 2017. 

Limitations

One limitation of this study was that its secondary outcome analysis (reoperation and complete or near complete resolution) were all subject to investigator bias, because reoperation was at investigator’s discretion once suboptimal surgical outcome criteria was met.

Clinical significance

The basic type of intermittent exotropia—the most common form of childhood-onset exotropia globally—can be treated with either bilateral lateral recession or recession-resection procedures with no statistically significant differences in long-term outcomes.