title: Long-Term Surgical Outcomes of Augmented Bilateral Lateral Rectus Recession in Children With Intermittent Exotropia.
abstract: OBJECTIVE
  To compare the long-term surgical outcomes of augmented bilateral lateral rectus (LR) recession with original surgery.
  
  
  METHODS
  Retrospective, nonrandomized clinical study.
  
  
  METHODS
  A total of 447 children with ≤35 prism diopters (PD) of basic and divergence excess-type intermittent exotropia, who underwent original bilateral LR recession based on the largest angle measured at distance and near, or augmentation surgery with the surgical dosage augmented by 1.0-1.5 mm more than the original formula were included. Patients were observed for at least 2 years. Success rates, cumulative probabilities of success, factors related to recurrence, and overcorrection were evaluated.
  
  
  RESULTS
  At a mean follow-up of 4.0 years, 48 of 101 patients (48%) undergoing original surgery maintained successful alignment within 10 PD of exophoria/tropia and 5 PD of esophoria/tropia; 49 (49%) had recurrence, and 3 (3%) had overcorrection. After augmented surgery, 203 of 346 patients (59%) were successfully aligned, 129 (37%) had recurrence, and 14 (4%) had overcorrection. Augmented surgery showed higher long-term successful alignment rates (P= .047) and lower recurrence rates compared to original surgery (P = .042) and the overcorrection rate was similar between the 2 groups (P= .774). Patients with divergence excess type showed higher cumulative success rates compared to that of the basic type (P = .010) after augmented surgery.
  
  
  CONCLUSIONS
  Augmented bilateral LR recession resulted in more successful alignment and lower recurrence without higher overcorrection compared to the original surgery for the children with intermittent exotropia. Augmentation of the original table should be considered when planning bilateral LR recession, especially in patients with divergence excess-type exotropia.
authors.affiliation: Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
authors.forename: Hyuna
authors.initials: H
authors.lastname: Kim
authors.affiliation: Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
authors.forename: Hee Kyung
authors.initials: HK
authors.lastname: Yang
authors.affiliation: Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea. Electronic address: hjm@snu.ac.kr.
authors.forename: Jeong-Min
authors.initials: JM
authors.lastname: Hwang
mesh_terms: D002648:Child; D005099:Exotropia / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009801:Oculomotor Muscles / Q000503:physiopathology / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D015348:Vision, Binocular / Q000502:physiology; D014792:Visual Acuity / Q000502:physiology