Bilateral Medical Rectus Advancement versus Bilateral Lateral Rectus Recession for Consecutive Exotropia

PURPOSE To compare bilateral medial rectus advancement (BMRA) and bilateral lateral rectus recession (BLRR) for the treatment of consecutive exotropia. METHODS This randomized clinical trial was performed on 14 patients with consecutive exotropia. Inclusion criteria were history of bilateral medial rectus recession, exotropia ≥20 PD with far-near discrepancy <10 PD. Exclusion criteria consisted of more than once medial rectus recession, restricted adduction, history of operation on the lateral rectus, positive forced duction test of the lateral rectus, concomitant neurologic disorders and follow-up less than 6 months' duration. RESULTS Seven patients underwent BMRA and 7 patients underwent BLRR. Mean age was 11.4±6.9 (range 5 to 21) years in the BMRA group and 13.7±7.1 (range 5-22) years in the BLRR group (P=0.44). Two patients in the BMRA group and 3 subjects in the BLRR group were amblyopic. Mean preoperative exotropia was 27.8±6.3 PD and 39.2±14.8 PD (P=0.09) which was reduced to 4.2±2.3 PD and 3.4±2.2 PD (P=0.94) in the BMRA and BLRR groups respectively. Successful alignment was achieved in 71.4% and 85.7% of cases in the BMRA and BLRR groups respectively (P=0.94). All amblyopic patients achieved successful alignment postoperatively. CONCLUSION Bilateral medial rectus advancement and bilateral lateral rectus recession are comparable in efficacy for treatment of consecutive exotropia.