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Purpose <p>To compare the clinical outcomes of lateral rectus (LR) recession and bupivacaine injection of medial rectus (MR) with conventional recession–resection (R&amp;R) surgery in patients with moderate-angle intermittent exotropia.</p> Methods <p>This prospective study included 105 patients with intermittent exotropia between 25 and 30 prism diopters (PD), treated at a single tertiary center. Patients were assigned to either bupivacaine injection of MR combined with LR recession (<i>n</i> = 53) or standard R&amp;R surgery (<i>n</i> = 52). Follow-up evaluations were conducted at 1, 6, 12, 18, and 24 months postoperatively. The primary outcome was surgical success, defined as exotropia ≤ 10 PD or esotropia ≤ 5 PD in the primary position. Secondary outcomes included postoperative angle changes, need for prism, and complication rates.</p> Results <p>The bupivacaine group demonstrated higher success rates than the R&amp;R group across all follow-up intervals; however, the differences were not statistically significant (all P-values &gt; 0.05). The R&amp;R group had significantly higher overcorrection rates (P-value &lt; 0.001), while none of the bupivacaine patients were overcorrected. The bupivacaine group consistently showed an undercorrection rate of 20.7%, which was significantly higher than the 7.7% rate in the R&amp;R group at all follow-up time points (P-value &lt; 0.001). No serious complications were reported in either group at all follow-up time points.</p> Conclusions <p>Adding bupivacaine injection of MR to LR recession appears to be a safe, effective, and minimally invasive alternative to traditional R&amp;R surgery for moderate-angle intermittent exotropia. It is associated with favorable outcomes, low complication rates, and no overcorrection. Further randomized, controlled trials with extended follow-up are necessary to confirm these findings.</p>

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Comparing lateral rectus recession and bupivacaine injection of medial rectus with conventional recession–resection in moderate-angle intermittent exotropia

  • 期刊论文

  • 发表日期：

    2026年3月25日

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  • Arash Mirmohammadsadeghi,
  • Alireza Razavi,
  • Mohammad Reza Akbari,
  • Motahhareh Sadeghi,
  • Babak Masoomian,
  • Hassan Asadigandomani

摘要

Purpose

To compare the clinical outcomes of lateral rectus (LR) recession and bupivacaine injection of medial rectus (MR) with conventional recession–resection (R&R) surgery in patients with moderate-angle intermittent exotropia.

Methods

This prospective study included 105 patients with intermittent exotropia between 25 and 30 prism diopters (PD), treated at a single tertiary center. Patients were assigned to either bupivacaine injection of MR combined with LR recession (n = 53) or standard R&R surgery (n = 52). Follow-up evaluations were conducted at 1, 6, 12, 18, and 24 months postoperatively. The primary outcome was surgical success, defined as exotropia ≤ 10 PD or esotropia ≤ 5 PD in the primary position. Secondary outcomes included postoperative angle changes, need for prism, and complication rates.

Results

The bupivacaine group demonstrated higher success rates than the R&R group across all follow-up intervals; however, the differences were not statistically significant (all P-values > 0.05). The R&R group had significantly higher overcorrection rates (P-value < 0.001), while none of the bupivacaine patients were overcorrected. The bupivacaine group consistently showed an undercorrection rate of 20.7%, which was significantly higher than the 7.7% rate in the R&R group at all follow-up time points (P-value < 0.001). No serious complications were reported in either group at all follow-up time points.

Conclusions

Adding bupivacaine injection of MR to LR recession appears to be a safe, effective, and minimally invasive alternative to traditional R&R surgery for moderate-angle intermittent exotropia. It is associated with favorable outcomes, low complication rates, and no overcorrection. Further randomized, controlled trials with extended follow-up are necessary to confirm these findings.