Jump to comment:

• Outcome of two-muscle surgery for large-angle intermittent exotropia in children - A comment
  Shailja Tibrewal
  Published on: 1 November 2016

• Published on: 1 November 2016

  Outcome of two-muscle surgery for large-angle intermittent exotropia in children - A comment

  • Shailja Tibrewal, Consultant
  • Other Contributors:
    • Raman Mehta, Batriti Wallang, Suma Ganesh

  We read the article titled "Outcome of two-muscle surgery for large- angle intermittent exotropia in children" by the authors Ki Won Jin and Dong Gyu Choi with great enthusiasm.1 The authors have compared the success of two muscle surgery for large angle (>=40 Prism Diopters (PD)) vs moderate-angle (>=20 and <30PD) intermittent exotropia. Neither of the two ranges described, include deviation between 30 to 39PD....

  Show More

  We read the article titled "Outcome of two-muscle surgery for large- angle intermittent exotropia in children" by the authors Ki Won Jin and Dong Gyu Choi with great enthusiasm.1 The authors have compared the success of two muscle surgery for large angle (>=40 Prism Diopters (PD)) vs moderate-angle (>=20 and <30PD) intermittent exotropia. Neither of the two ranges described, include deviation between 30 to 39PD. Whether these deviations were excluded or this is a typographical error is subject to speculation. The range of exotropia in the large angle group was upto 70PD. Several prior studies have shown that success rates of two muscle surgery drop down significantly as the exotropia increases beyond 50PD2 and therefore three or four muscle surgery is recommended.3 Including such larger deviations skews the data and the chances of failure automatically increases in Group A of the study. We believe that a better comparison would have been between the moderate angle group and a second group of 35 - 50PD. None of the patients in the above study had symptomatic diplopia in lateral gaze or palpebral fissure changes at any postoperative visit in spite of performing large 9.5mm lateral rectus recession and 7mm medial rectus recession in at least some of the patients. This observation is unlike prior observations4 and our experience too with large recess-resect surgery. Lastly the authors have not compared the two groups in terms of refractive error which is an important factor leading to variations in preoperative measurement of deviation and the effect of surgery.5 Nonetheless we would like to congratulate the authors for conducting this important study that probably suggests that large angle intermittent exotropia warrants more than two horizontal rectus muscle surgery in order to achieve motor success in majority of patients.

  Conflict of Interest:

  None declared

  Show Less

  Conflict of Interest:
  None declared.

  • Back to top