ArticleTherapeutics and clinical risk management2025
A Stratified Surgical Approach for Convergence Insufficiency-Type Exotropia Based on Near Deviation Magnitude: A Retrospective Cohort Study of Motor and Sensory Outcomes.
Article in Therapeutics and clinical risk management, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: To evaluate the efficacy and safety of a stratified surgical strategy for convergence insufficiency-type exotropia (CIX(T)) tailored to the magnitude of near deviation, with a primary outcome of postoperative motor success (orthophoria) and a secondary outcome of stereopsis improvement. Methods: This retrospective cohort study included 85 CIX(T) patients (near deviation ≥ distance deviation by 15Δ) treated between July 2015 and June 2022. Patients were stratified into three groups based on near deviation magnitude. Group 1 (n=15, <30Δ) underwent unilateral medial rectus resection; Group 2 (n=38, 30-80Δ) received unilateral lateral rectus recession combined with medial rectus resection; Group 3 (n=32, 85-130Δ) underwent bilateral lateral rectus recession plus unilateral medial rectus resection. Ocular alignment (prism cover test) and stereopsis (Titmus test) were assessed preoperatively, at 1 week (short-term), and 3 months (intermediate-term) postoperatively. Results: Baseline characteristics were comparable across groups, except for the stratification variable of near deviation. At the 3-month follow-up, motor success was achieved in 20.0% of Group 1, 89.5% of Group 2, and 87.5% of Group 3. Group 1 showed a high rate of undercorrection (80.0%), whereas Groups 2 and 3 demonstrated stable alignment with minimal undercorrection (10.5% and 9.4%, respectively). Stereopsis scores significantly improved from preoperative levels in Group 2 (P<0.001) and Group 3 (P<0.001), but regressed in Group 1 (P>0.05). A planned slight initial overcorrection (10-15Δ) at distance was significantly correlated with better intermediate-term alignment (r = 0.68, 95% CI: 0.51 to 0.80, P<0.001). Conclusion: These findings support a stratified surgical approach for CIX(T) based on near deviation magnitude. While combined recession-resection procedures are effective for moderate-to-large angle deviations, unilateral medial rectus resection for small-angle CIX(T) resulted in high rates of undercorrection. This suggests that the surgical plan for small-angle CIX(T) may require more aggressive dosages or alternative strategies.
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