Palpebral Fissure Changes After Bilateral Recession Versus Unilateral Recession-Plication of Horizontal Rectus Muscles for Correction of Intermittent Exotropia

Abstract

Purpose: To compare changes of vertical palpebral fissure height after bilateral lateral rectus (BLR) recessions versus unilateral lateral rectus (LR) recession and medial rectus (MR) muscle scleral plication, for treatment of intermittent exotropia.

Methods: This prospective, comparative, randomized study included 40 patients with intermittent exotropia who were divided into two groups: 20 patients who underwent BLR recessions (BLR recession group) and 20 patients who underwent unilateral LR recession and MR muscle scleral plication (recession-plication group). Eyelid evaluation included measurement of margin reflex distance 1 (MRD1) and margin reflex distance 2 (MRD2) at 1 week, 6 weeks, and 3 months postoperatively. Angle of deviation and any incomitance were also recorded at each visit.

Results: There was no significant statistical difference in eyelid measurements after the surgery between both groups (P = 1.00). There was no significant statistical difference in ocular alignment after the surgery between both groups (P = 1.00). Also, there was no significant statistical difference in lateral incomitance after the surgery between both groups (P = 1.00).

Conclusions: Both the unilateral recession and plication of horizontal rectus muscles technique and bilateral recession provide comparable surgical results for correction of exotropia without significant palpebral fissures changes or lateral incomitance. [J Pediatr Ophthalmol Strabismus. 2025;62(3):182-189.].