Surgical outcomes of bilateral lateral rectus recession versus unilateral recession and resection for the divergence excess type of intermittent exotropia

Purpose: To compare bilateral lateral rectus recession (BLR) with unilateral recession and resection (RR) for divergence excess intermittent exotropia (IXT).Methods: Retrospective analysis of 66 patients with divergence excess IXT who underwent either BLR or RR from January 2013 to December 2020 was conducted. Data on demographics, pre- and postoperative deviations, fusion, stereopsis, control, and accommodative convergence/accommodation ratio were collected. Success was defined as esodeviation <= 5 PD (prism diopter) to exodeviation <= 10 PD with a follow-up time of at least 8.0 +/- 2.0 weeks.Results: BLR (42 cases) and RR (24 cases) groups had the same success rate (83.3%, P = 0.688) and similar reduced postoperative deviations both in distance and at near (P > 0.05). Near-distance disparity decreased significantly in both groups (P = 0.000) with no intergroup difference (P = 0.193).Conclusion: BLR and RR were equally effective for divergence excess IXT with comparable outcomes of both distance and near deviations.