Bilateral versus unilateral recession outcomes for intermittent exotropia
Reviewed by Fiona Rowe

The aim of this study was to compare surgical motor and sensory outcomes of unilateral versus bilateral lateral rectus recessions in children with small angle intermittent exotropia. This was a retrospective study of 55 patients; 28 bilateral and 27 unilateral surgery. Both groups were similar at baseline except that bilateral cases had greater angles of deviation. For bilateral recessions, mean surgery was 5.5 ±0.6mm per muscle or 0.53 ±0.06mm/PD – range 5-7mm per muscle. For unilateral recessions, mean surgery was 7.5 ±0.4mm per muscle or 0.41 ±0.04mm/PD – range 5-8.5mm per muscle. At follow-up of 12 months, 13/28 had a successful outcome with bilateral recessions (46%) versus 19/27 for unilateral recessions (70%). There was a statistically significant trend toward a higher fail rate with bilateral recessions. No specific factors were found to be associated with poor outcome. There was no lateral incomitance >10PD at follow-up. Risk of loss of central fusion was low. The authors acknowledge the small sample size and retrospective nature of this study. They discuss the advantages of unilateral surgery and recommend a prospective trial of surgical options.

Comparison of unilateral vs bilateral lateral rectus recession for small angle intermittent exotropia: outcomes and surgical dose-response.
Lee M-HH, Smith DR, Kraft SP, Wan MJ.
JOURNAL OF PEDIATRIC OPHTHALMOLOGY AND STRABISMUS
2022;59(5):350-5.