Comparative Analysis of Three Surgical Approaches for Managing Convergence Insufficiency Intermittent Exotropia in Pediatric Patients

Abstract

Introduction This study compared three surgical approaches for convergence insufficiency intermittent exotropia (CI-X[T]) in children to identify the most effective method. Methods Fifty-eight children aged 4–13 years with CI-X(T) and near-distance disparity ≥10 prism diopters (PD) were prospectively randomized to: (1) Bilateral Lateral Rectus Recession (BLR), (2) Unilateral Recession–Resection (RR), or (3) Medial Rectus Resection (MRR). Surgical outcomes were defined as postoperative deviation within 5 PD of esophoria/tropia and 10 PD of exophoria/tropia. Patients were followed for 24 months. Results At the final follow-up, cumulative success rates were similar among BLR (52.4% near, 81.0% at distance), RR (30.4% near, 43.5% at distance), and MRR (27.3% near, 50.0% at distance). Near exodeviation decreased significantly in all groups (p < 0.001). NDD correction was achieved in 59.1% of MRR, 50.0% of BLR, and 30.4% of RR patients (p = 0.142). Stereopsis improved comparably across groups. Complications included overcorrection and A/V patterns in BLR, undercorrection in RR, and persistent consecutive esotropia in MRR. Discussion All three surgical approaches were effective, with BLR favoring distance correction, RR showing short-term near benefits, and MRR demonstrating balanced long-term outcomes, including improvement in the AC/A ratio. Conclusion MRR appears to be the most reliable overall, although individual patient characteristics should guide surgical choice. Larger, long-term studies are needed.