ArticleGraefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie2026
Y-split versus standard lateral rectus recession for sensory exotropia: a propensity-score adjusted cohort study.
Article in Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, 2026. 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
purposeThe Y-split lateral rectus recession has biomechanical advantages in incomitant strabismus, but its role as a primary weakening procedure for comitant large-angle exotropia is unclear. We compared surgical success and mechanical efficiency between Y-split and standard recession in predominantly sensory exotropia.
methodsThis retrospective study included 86 patients (41 standard, 45 Y-split; recession 7-9 mm). Success was a 6-month distance deviation < 10 PD. Non-random allocation was addressed with inverse-probability weighting (IPTW), propensity-score matching, overlap weighting, entropy balancing, and recession adjustment. Eyes were classified as sensory exotropia or divergence excess by acuity criteria. An E-value assessed unmeasured confounding. Reported per STROBE.
resultsThe Y-split group had larger deviations (median 40 vs. 30 PD, p < 0.001) and poorer acuity (logMAR 1.0 vs. 0.1, p = 0.001). Unadjusted success was 48.9% (Y-split) versus 36.6% (standard, p = 0.35); no consecutive esotropia occurred. After IPTW, success odds were higher with Y-split (OR 4.75, 95% CI 1.86-12.12, p = 0.001). Corrective efficiency was 3.4-3.9 versus 2.4-2.7 PD/mm. The advantage persisted with overlap weighting (OR 6.49), recession adjustment (OR 5.66), across deviation strata (Mantel-Haenszel OR 11.0), and within the sensory exotropia subgroup (OR 4.54); all remained significant after false-discovery-rate correction. Complications were not systematically recorded.
conclusionY-split lateral rectus recession provided 30-40% more correction per millimetre and four- to five-fold higher adjusted odds of short-term success than standard recession, even in eyes with worse prognosis. It is a candidate procedure for large-angle sensory exotropia on preliminary evidence, requiring prospective confirmation with safety monitoring and at least 24 months of follow-up.
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