Slanted lateral rectus recession for exotropia with convergence weakness

Objective: To evaluate the efficacy of slanted recession of the lateral rectus (LR) muscle for exotropia (XT) with convergence weakness. Design: Predesigned, nonrandomized, comparative trial. Participants: Twelve study patients and six control subjects with XT greater at near than at distance by ≥10 prism diopters (PD). Intervention: Twelve consecutive patients underwent slanted LR recession, and six consecutive control subjects underwent standard LR recession. Main Outcome Measures: Between-groups comparison of the postoperative ocular alignment at distance and near, and the difference between them, as well as the stereopsis. Results: Slanted LR recession reduced the XT to <8 PD in all patients at distance and in 11/12 patients at near. Additionally, the mean difference between the distance and near exodeviation was reduced from 14 ± 4.5 PD preoperatively to 2.9 ± 2.4 PD postoperatively. All patients in the control group demonstrated postoperative deviations of <8 PD at distance, but all had residual exodeviations >8 PD at near. Three of the study patients gained gross stereopsis postoperatively. Conclusions: Slanted recession of the LR is superior to standard recession in reducing both distance and near XT and in collapsing the difference between them. This technique may also have a positive impact on gross stereopsis.