Intermittent and constant exotropia are common strabismus conditions treated by pediatric ophthalmologists. Since the early 1980s, I have been a proponent of unilateral strabismus surgery for moderate angles of strabismus. The success rate for unilateral surgery has been similar to the success rate for bilateral surgery. There are several advantages of unilateral versus bilateral surgery. Unilateral surgery involves surgery on only one eye, anesthesia time is less, and it leaves the other eye available if further surgery is necessary.
In this issue, Thorisdottir et al had excellent short-term and long-term success with unilateral surgery for exotropia. The authors should have been specific as to their numbers used in the surgery, considering that different surgeons used a different surgical approach. I do not believe that applying unilateral lateral rectus surgery for exodeviations that were greater at distance and unilateral medical rectus surgery for those greater at near would give a better outcome. I would be concerned about using the near deviation that was larger as the criterion for surgery because it may lead to diplopia at distance fixation. The authors state that because the study was retroactive, there was limited information on postoperative incomitance. I have not found postoperative incomitance to be a significant occurrence. There are other publications demonstrating the success of unilateral strabismus surgery.
Leonard B. Nelson, MD