Long-term comparison of horizontal rectus surgery with vertical tendon transposition and combined vertical tendon transposition and inferior oblique–weakening in V-pattern exotropia

Purpose

To compare the efficacy of bilateral lateral rectus recession with vertical tendon transposition (LRVT) and LRVT combined with inferior oblique (IO) disinsertion for V-pattern exotropia.

Methods

The medical records of patients who had mild-to-moderate (+1 and +2) inferior oblique overaction (IOOA) and underwent half-tendon-width upward LRVT (transposition group), and LRVT with IO disinsertion (combined surgery group) for V-pattern exotropia and who had at least 3 years of postoperative follow-up were reviewed retrospectively.

Results

A total of 45 patients were included: 22 in the transposition group and 23 in the combined surgery group. Preoperatively, there were no differences in V pattern, IOOA, or horizontal misalignment in primary position, upgaze, or downgaze between groups. The amount of exotropia in the primary position was 30.2^Δ ± 10.7^Δ in the transposition group, and 31.6^Δ ± 14.1^Δ in the combined surgery group (P = 0.974). A significant decrease in V pattern was observed in the combined surgery group and the transposition group at 6 months and 3 years postoperatively (P < 0.001). The reduction of V pattern in the combined surgery group at 6 months (20.2^Δ ± 7.8^Δ vs 15.6^Δ ± 6.9^Δ [P = 0.02]) and 3 years (20.1^Δ ± 8.1^Δ vs 15.2^Δ ± 7.1^Δ [P = 0.014]) was found to be greater than the transposition group. There were no differences in the success rate in the primary position at 6 months (P > 0.05).

Conclusions

Both tendon transposition with horizontal rectus surgery and combined tendon transposition and IO-weakening surgery decreased V-pattern exotropia. However, combined surgery had a greater effect on decreasing V pattern in patients with mild-to-moderate IOOA.