Background V-pattern intermittent exotropia (IXT) is defined by greater than or equal to 15 prism diopters (Δ), greater deviation in upgaze than downgaze, with many surgical techniques to overcome it. Aim To assess and compare the surgical outcomes of managing V-pattern IXT without notable inferior oblique overaction (IOOA) managed by bilateral lateral rectus (BLR) recession alone versus BLR recession combined with an upward transposition of lateral rectus insertion by half a tendon width. Patients and methods A randomized, prospective, interventional, comparative study included 20 patients (40 eyes) with V-pattern IXT without significant IOOA. Participants were randomized into two groups: group A ( n =10) underwent BLR recession alone, and group B ( n =10) underwent BLR recession along with upward transposition of the lateral rectus. All patients underwent preoperative and postoperative assessments, including prism cover testing and ocular motility evaluation, with follow-up for 6 months. Outcomes included postoperative alignment, change in V-pattern deviation, and pattern collapse rates. Data analysis was performed using SPSS version 25, considering P values less than 0.05 as statistically significant. Results Both groups showed a significant postoperative reduction in exodeviation. Pattern collapse occurred more frequently in group B, highlighting the added benefit of upward transposition in managing V-pattern deviation. Conclusion Both surgical techniques effectively reduced exodeviation in cases with V-pattern IXT without IOOA. However, the BLR recession combined with upward transposition provided superior efficacy in reducing pattern deviation. Future studies with extended follow-up are recommended to determine the durability of these findings.
Oun et al. (Wed,) studied this question.