| Purpose:To evaluate the occurrence of lateral incomitance(LI)before and after unilateral rectus recession-resection(Rc&Rs)and to explore the correlation between LI and surgery.This study aims to provide a valuable reference for surgical design.Methods:This study was a retrospective case review.Patients with exotropia treated with Rc&Rs in the second hospital of Jilin University from December 2021 to February 2022 with complete follow-up data were recruited.All patients received general ophthalmic and strabismus specialist examinations,including visual acuity,refraction,stereopsis,strabismus angle,eye movements,and compensatory head posture.The above data were recorded preoperatively and postoperatively(one week,six months,and one year after surgery).Near stereopsis was measured using the Titmus stereo test.The ocular deviation was measured using the alternate prism and cover test at distance(6 m)in primary and lateral gaze.We used 30° of head turn and the neutralizing prism was placed over the adducting eye in measurements of lateral gaze deviations.The results of stereopsis were recorded as “nil” when patients could not identify the picture of 800 seconds of arc.The stereoacuity of less than 100 seconds of arc was considered to be good.LI was defined as a decrease of more than 5 PD in exodeviation in the distance at right or left gaze.Surgical success was defined as esotropia of ≤5 prism diopters(PD)to exotropia of ≤10 PD according to postoperative angle of deviation.These data were split into two sets according to whether or not the preoperative LI(pre LI)was.The final evaluation was performed with the Statistical Package for Social Sciences version 26.0 software(SPSS,Inc).Results:1.During the enrollment period,a total of 153 patients were included,of whom93 were male and 60 were female.The age at the time of surgery was from 4 to 29 years,and the mean final follow-up visit was 12.1±0.9 months.The preoperative exodeviation angles ranged from-20 to-75 PD in both the LI+ and LI-groups.2.The overall incidence of pre LI was 60.1%(92/153),early postoperative period70.6%(108/153),intermediate-term postoperative period 63.4%(97/153),and final follow-up 55.6%(85/153).The incidence of LI was significantly lower at the final follow-up compared with the early postoperative period,and the difference was statistically significant(P=0.006).3.Overall surgical success rate was 87.6% in the early postoperative period,and there were no differences(P=0.073)between pre LI+ and pre LI-(83.7% and 93.4%,respectively).In the intermediate-term postoperative period,the surgical success rate was 81.7%,85.9% in the pre LI+ group and 75.4% in the pre LI-group(P=0.101).At the final follow-up,the surgical success rate was 81.0%,78.3% in the pre LI+ group and85.2% in the pre LI-group(P=0.280).A total of 18 patients showed overcorrection in the early postoperative period,14(15.2%)in the pre LI+ group and 4(6.6%)in the pre LI-group(P=0.104);at the intermediate-term postoperative period,only one case in the pre LI+ group was overcorrected.At the final follow-up,there was also only one overcorrection in the pre LI+ group(P=1.000).4.Among patients with pre LI+,70.7% still had LI in the early postoperative period,and among patients with pre LI-,70.5% had new LI in the early postoperative period(P=0.983).5.Preoperatively,105 patients had stereopsis,including 64 patients(69.6%)in the pre LI+ group and 41 patients(67.2%)in the pre LI-group(P=0.759);93 patients had good stereopsis,including 56 patients(60.9%)in the pre LI+ group and 37 patients(60.7%)in the pre LI-group(P=0.979).In the early postoperative period,135 had stereopsis,including 83(90.2%)in the pre LI+ group and 52(85.2%)in the pre LI-group(P=0.350);by the intermediate or late postoperative period,151 had stereopsis,including 91(98.9%)in the pre LI+ group and 60(98.4%)in the pre LI-group(P=1.000).In the early postoperative period,77.2% of patients in the pre LI+ group and 75.4% of patients in the pre LI-group had good stereopsis(P=0.801);by the intermediate-term postoperative period,91.3% of patients in the pre LI+ group and 90.2% of patients in the pre LI-group had good stereopsis(P=0.811),and at the final follow-up,95.7% of patients in the pre LI+ group and 95.1% of patients in the pre LI-group had good stereopsis(P=1.000).Preoperatively,68.6% of patients had stereopsis,88.2% in the early postoperative period,98.7% in the intermediate period,and the final follow-up was the same as the intermediate period(P<0.001).Preoperatively,60.8% of patients had good stereopsis,which increased to 76.5% in the early postoperative period,90.8%in the intermediate period,and 95.4% at the final follow-up(P<0.001).6.Postoperatively,different degrees of abduction limitation in the operated eye were found,but the abduction limitation was significantly better with time(P<0.001).It was apt to express abduction limitation when Rc+Rs>8mm in this study.Abduction limitation was seen in 95.4% of patients with LI+ in the early postoperative period,which was higher than 68.9% of patients in the LI-group(P<0.001),so patients with abduction limitation in the early postoperative period were more likely to have combined LI.10 patients(6.5%)in the early postoperative period complained of diplopia during lateral gaze of the operated eye,mainly in adult patients with binocular vision,who did not feel diplopia in the primary gaze,but only in lateral gaze,so a compensatory head posture is required when gazing laterally.Conclusions:LI was widely present preoperatively when defined by the "5PD".Rc&Rs can cause new LI,and postoperative LI was not related to the pre LI.Postoperatively,there are varying degrees of abduction limitation on the side of lateral rectus recession,and beyond a certain level of surgical volume can lead to an increase in the incidence of abduction limitation,and abduction limitation correlates with LI in the early postoperative period,and abduction limitation is significantly better at the final followup than in the early postoperative period.The presence of pre LI does not affect the recovery of stereopsis,surgical success rate,or increase the risk of overcorrection.Patients with pre LI can design the surgery in the usual way. |
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