Botulinum toxin augmented bilateral lateral rectus recession versus three muscles surgery in large-angle intermittent exotropia

作     者：Hala Kamal Mattout Sameh Mosaad Fouda Wael M El-Haig 

作者机构：Department of OphthalmologyFaculty of MedicineZagazig UniversityZagazig 44519Egypt 

出 版 物：《International Journal of Ophthalmology(English edition)》 (国际眼科杂志（英文版）)

年 卷 期：2022年第15卷第10期

页      面：1665-1670页

核心收录：

学科分类：1002[医学-临床医学] 100212[医学-眼科学] 10[医学] 

主　　题：botulinum toxin intermittent exotropia large angle deviation augmented surgery 

摘      要：AIM: To report the surgical outcomes of correcting large angle intermittent exotropia in adult patients by bilateral lateral rectus muscle recession with intraoperative use of botulinum toxin and to compare the results with those of bilateral lateral rectus muscle recession and unilateral medial rectus resection. METHODS: The medical records of patients who underwent surgical correction of large angle intermittent exotropia [exotropia 50 prism dioptre(PD)] were retrospectively reviewed. Two groups of patients were identified;Group Ⅰ(21 patients) had bilateral lateral recti recession augmented with intraoperative botulinum toxin A(BTA) injection into the recessed muscles and group Ⅱ(30 patients) were treated by bilateral lateral recti recession with unilateral medial rectus muscle resection. Preoperative data were extracted for age, gender, refraction, type of exotropia, angle of stereopsis and angle of deviation. The main outcome measures were the postoperative angle of deviation and stereoacuity angle by Titmus test measured at the end of one year of postoperative follow up. RESULTS: By the end of the first postoperative year, 10 patients in group Ⅰ(47.6%) and 20 patients in group Ⅱ(66.7%) achieved esotropia/esophoria 5 PD or exotropia/exophoria 10 PD. The difference in surgical success rate was not statistically significant(P=0.1) but there was a statistically significant higher rate of undercorrection in group Ⅰ(P=0.03). On the other hand, 3 patients in group Ⅰ(14.3%) and 5 patients in group Ⅱ(16.7%) had improved stereopsis;this difference in the sensory outcome was not statistically significant(P=0.8). In the BTA augmented surgery group, good stereoacuity and smaller preoperative angle of deviation were associated with significantly higher surgical success rate(P=0.004, 0.01 respectively). CONCLUSION: BTA augmented bilateral lateral recti recession is associated with higher rate of undercorrection as compared to bilateral lateral recti recession with unilater