Surgical outcomes in convergence insufficiency-type exotropia.

Objective: To determine the efficacy of different types of strabismus surgeries in patients with convergence insufficiency (CI)-type exotropia, according to their response to diagnostic monocular occlusion. Methods: Retrospective cohort study. Methods: Sixty-five patients with CI-type exotropia with near-distance differences of ≥10 prism diopters (PD) who underwent strabismus surgery. Methods: Patients were divided into 3 groups according to their response to monocular occlusion: (1) true-CI group: near-distance differences ≥10 PD before and after occlusion; (2) masked-CI group: near-distance differences <10 PD before occlusion and ≥10 PD after occlusion; and (3) pseudo-CI group: near-distance differences ≥10 PD before occlusion and <10 PD after occlusion. Either bilateral lateral rectus recession based on near measurements with 1 mm augmentation (BLR) or unilateral medial rectus resection based on the near deviation with lateral rectus recession based on the distant deviation (RR) was performed. Methods: Cumulative probabilities of success, near-distance differences of exodeviation, rate of recurrence per person-year, and risk factors of recurrence. Results: There were 24 children in the true-CI group, 19 children in the masked-CI group, and 22 children in the pseudo-CI group. The cumulative probabilities of success at 2 years after BLR versus RR were 61% versus 100% in the true-CI group, 58% versus 100% in the masked-CI group, and 77% versus 71% in the pseudo-CI group. The RR procedure was significantly more successful than the BLR procedure in the true-CI and masked-CI groups. Conclusions: Successful outcome in CI-type exotropia was closely related to the patients' response to monocular occlusion. In patients with CI-type exotropia maintained after monocular occlusion, unilateral resection-recession based on near-distance measurements is recommended.

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