Comparative Study Between Recession Versus Fenestration of the Lateral Rectus Muscle in Treating Intermittent Exotropia

Background: The most common form of exotropia, an outward deviation of the eyes, is intermittent exotropia. Surgically, this condition is treated by weakening the lateral rectus muscle, with recession with scleral suturing being the standard technique. However, there is an alternative weakening procedure called muscle fenestration that can avoid many of the complications that can occur with scleral suturing. About one percent of children under the age of eleven suffer from exotropia. Aim and objectives: To compare the surgical outcome of bilateral lateral rectus fenestration versus the standard bilateral lateral rectus recession with scleral suturing using 6-0 Vicryl sutures in treating intermittent exotropia. Subjects and methods: This randomized interventional comparative study was carried out on 40-patients of intermittent exotropia at Giza Memorial Institute of Ophthalmic Research, Kids Eye Center through the period from July 2021 till 2023. Two groups were formed from the patients: Twenty patients having prior scleral tunnel surgery for bilateral lateral rectus recession were included in the recession group. Twenty individuals who were part of the fenestration group had lateral rectus fenestration done on both sides. Results: Both techniques were effective in treating intermittent exotropia, as orthotropia was achieved in 70% and 65% of patients for near and distant fixation, respectively, during the economic downturn. With both close and far fixation, half of the patients in the fenestration group were able to attain orthotropia. Conclusion: Intermittent exotropia can be treated effectively by fenestration of the LR muscle with comparable results to the standard recession. One risk-free method for reducing the strength of muscles outside the eye is fenestration.