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Purpose <p>This study aimed to evaluate a novel surgical approach combining unilateral lateral rectus recession (LRc) with compartmentalized inferior medial rectus plication (CIMRP) for treating small-angle (&lt; 25 prism diopters, PD) convergence insufficiency intermittent exotropia (CI-IXT) in pediatric patients.</p> Methods <p>A retrospective analysis was conducted on 69 pediatric CI-IXT patients (mean age: 8.13 ± 2.46 years; range: 4–14 years) who underwent unilateral LRc and CIMRP between September 2022 and January 2024 at Tianjin Eye Hospital. All patients completed a minimum 12-month follow-up (mean: 12.41 ± 1.42 months; range: 12–18 months). Outcomes including near and distance deviations, near-distance difference (NDD), control scores, stereopsis, and complications were assessed preoperatively and postoperatively at 1&#xa0;day, 2 months, 6 months, and final follow-up (12–18 months). Surgical success was defined as an exodeviation ≤ 10 PD or esodeviation ≤ + 5 PD in primary gaze at distance and near, and NDD ≤ 8 PD.</p> Results <p>The mean LRc amount was 7.08 ± 0.48&#xa0;mm (range: 6.5–7.5&#xa0;mm), and the mean CIMRP amount was 3.56 ± 0.39&#xa0;mm (range: 3.0–4.0&#xa0;mm). Significant reductions were observed in near exo-deviation (median: −30 [− 32, − 28] PD to − 12 [− 16, − 6] PD), distance deviation (− 20 [− 20, − 18] PD to − 6 [− 10, − 1] PD), and NDD (10 [10, 10] PD to 4 [4, 6] PD; all <i>P</i> &lt; 0.001, Friedman test).Simple linear regression identified an exploratory association between CIMRP amount and corrected NDD (defined as preoperative NDD minus postoperative NDD): Corrected NDD = 5.973 × CIMRP (mm) − 12.48 (<i>P</i> &lt; 0.0001, R² = 0.2042). This indicates that each 1&#xa0;mm increase in plication amount was associated with an average increase of approximately 5.97 PD in NDD correction within the observed 3.0–4.0&#xa0;mm range. Surgical success was achieved in 88.41% at both 2 and 6 months, decreasing slightly to 81.16% at the final follow-up. The overcorrection rate peaked at 8.7% at 2 months and subsequently stabilized at 2.9%, whereas the undercorrection rate gradually increased to 15.9%. Control scores and near stereoacuity improved significantly after surgery (<i>P</i> &lt; 0.001 and <i>P</i> &lt; 0.05, respectively).</p> Conclusion <p>Unilateral LRc combined with CIMRP is an effective and safe approach for small angle CI-IXT (&lt; 25 PD). Based on preliminary evidence from this exploratory analysis, we tentatively suggest CIMRP of ≥ 3.5&#xa0;mm for preoperative NDD &gt; 10 PD, pending prospective validation. While this targeted technique addresses convergence insufficiency with favorable outcomes, further comparative studies are needed to define its clinical role.</p>

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Selective compartmental plication in small-angle convergence insufficiency exotropia: surgical outcomes and predictive model

  • 期刊论文

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  • 发表日期：

    2026年8月3日

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  • Juan Ding,
  • Pin Zhu,
  • Liping Chen,
  • Rui Hao,
  • Wei Zhang,
  • Yueping Li

摘要

Purpose

This study aimed to evaluate a novel surgical approach combining unilateral lateral rectus recession (LRc) with compartmentalized inferior medial rectus plication (CIMRP) for treating small-angle (< 25 prism diopters, PD) convergence insufficiency intermittent exotropia (CI-IXT) in pediatric patients.

Methods

A retrospective analysis was conducted on 69 pediatric CI-IXT patients (mean age: 8.13 ± 2.46 years; range: 4–14 years) who underwent unilateral LRc and CIMRP between September 2022 and January 2024 at Tianjin Eye Hospital. All patients completed a minimum 12-month follow-up (mean: 12.41 ± 1.42 months; range: 12–18 months). Outcomes including near and distance deviations, near-distance difference (NDD), control scores, stereopsis, and complications were assessed preoperatively and postoperatively at 1 day, 2 months, 6 months, and final follow-up (12–18 months). Surgical success was defined as an exodeviation ≤ 10 PD or esodeviation ≤ + 5 PD in primary gaze at distance and near, and NDD ≤ 8 PD.

Results

The mean LRc amount was 7.08 ± 0.48 mm (range: 6.5–7.5 mm), and the mean CIMRP amount was 3.56 ± 0.39 mm (range: 3.0–4.0 mm). Significant reductions were observed in near exo-deviation (median: −30 [− 32, − 28] PD to − 12 [− 16, − 6] PD), distance deviation (− 20 [− 20, − 18] PD to − 6 [− 10, − 1] PD), and NDD (10 [10, 10] PD to 4 [4, 6] PD; all P < 0.001, Friedman test).Simple linear regression identified an exploratory association between CIMRP amount and corrected NDD (defined as preoperative NDD minus postoperative NDD): Corrected NDD = 5.973 × CIMRP (mm) − 12.48 (P < 0.0001, R² = 0.2042). This indicates that each 1 mm increase in plication amount was associated with an average increase of approximately 5.97 PD in NDD correction within the observed 3.0–4.0 mm range. Surgical success was achieved in 88.41% at both 2 and 6 months, decreasing slightly to 81.16% at the final follow-up. The overcorrection rate peaked at 8.7% at 2 months and subsequently stabilized at 2.9%, whereas the undercorrection rate gradually increased to 15.9%. Control scores and near stereoacuity improved significantly after surgery (P < 0.001 and P < 0.05, respectively).

Conclusion

Unilateral LRc combined with CIMRP is an effective and safe approach for small angle CI-IXT (< 25 PD). Based on preliminary evidence from this exploratory analysis, we tentatively suggest CIMRP of ≥ 3.5 mm for preoperative NDD > 10 PD, pending prospective validation. While this targeted technique addresses convergence insufficiency with favorable outcomes, further comparative studies are needed to define its clinical role.