PURPOSE: To evaluate the state and symmetry of accommodative response in the two eyes of patients with basic intermittent exotropia and to determine whether accommodative response is a predicting factor to the outcome of unilateral recession-resection procedures or symmetric lateral rectus recessions. METHODS: Dynamic retinoscopy was performed preoperatively on 47 patients with basic intermittent exotropia with the capacity for fusion who were undergoing a first operation for intermittent exotropia. To obtain a clinical measurement of the degree of binocular accommodative response, the monocular estimate method was used. Patients were divided into two groups: those with an "equal effective accommodative response" and those with an "unequal accommodative response" between the two eyes. Both groups received either unilateral recession-resection procedures or symmetric lateral rectus recessions. RESULTS: Thirty-two of 47 patients (68%) showed a persistent interocular difference in accommodative amplitude (asymmetric accommodation) of at least 0.75 D. Among these 32 patients with an "unequal effective accommodation," 5 of 14 patients (35.7%) receiving lateral rectus recessions had a satisfactory outcome compared with 13 of the 18 patients (72%) receiving recess/resect procedures (p = 0.039). Of the 15 patients with an "equal effective accommodation," 7 of 8 (87%) receiving recession-resection procedures had a satisfactory outcome compared with 5 of 7 patients (71%) who had lateral rectus recessions (p = 0.57). CONCLUSIONS: Data suggest that patients with an asymmetric accommodative response benefit more from recession-resection procedures. A decrease in accommodative response of the nondominant eye could be a predicting factor on the outcome of exotropia surgery.
PURPOSE: To evaluate the state and symmetry of accommodative response in the two eyes of patients with basic intermittent exotropia and to determine whether accommodative response is a predicting factor to the outcome of unilateral recession-resection procedures or symmetric lateral rectus recessions. METHODS: Dynamic retinoscopy was performed preoperatively on 47 patients with basic intermittent exotropia with the capacity for fusion who were undergoing a first operation for intermittent exotropia. To obtain a clinical measurement of the degree of binocular accommodative response, the monocular estimate method was used. Patients were divided into two groups: those with an "equal effective accommodative response" and those with an "unequal accommodative response" between the two eyes. Both groups received either unilateral recession-resection procedures or symmetric lateral rectus recessions. RESULTS: Thirty-two of 47 patients (68%) showed a persistent interocular difference in accommodative amplitude (asymmetric accommodation) of at least 0.75 D. Among these 32 patients with an "unequal effective accommodation," 5 of 14 patients (35.7%) receiving lateral rectus recessions had a satisfactory outcome compared with 13 of the 18 patients (72%) receiving recess/resect procedures (p = 0.039). Of the 15 patients with an "equal effective accommodation," 7 of 8 (87%) receiving recession-resection procedures had a satisfactory outcome compared with 5 of 7 patients (71%) who had lateral rectus recessions (p = 0.57). CONCLUSIONS: Data suggest that patients with an asymmetric accommodative response benefit more from recession-resection procedures. A decrease in accommodative response of the nondominant eye could be a predicting factor on the outcome of exotropia surgery.