Motor alignment and sensory outcomes in pediatric patients with basic-type intermittent exotropia after bilateral lateral rectus recession versus unilateral recession–resection

To compare motor alignment and sensory outcomes after bilateral lateral rectus recession (BLR) versus unilateral lateral rectus recession with medial rectus resection (R&R) in children with basic-type intermittent exotropia (IXT). This retrospective cohort study included 48 patients with basic-type IXT who underwent BLR ( n = 26) or unilateral R&R ( n = 22). Assessments were performed preoperatively and at 1 month and 1 year postoperatively. Deviation angles were measured in prism diopters (PD). Near stereopsis was analyzed after log transformation, and sensory status was evaluated using the Worth 4-dot test. The primary outcome was 1-year motor success, defined as a residual deviation ≤ 10 PD. Baseline characteristics were similar between groups (all p > 0.05). Motor success rates were comparable between BLR and R&R at 1 month (92% vs. 91%; p = 1.000) and 1 year (88% vs. 86%; p = 1.000). Orthophoria rates (77% vs. 68%; p = 0.497) and reoperation rates (12% vs. 14%; p = 0.827) were also similar. Deviation decreased significantly over time ( p < 0.001). Stereopsis improved postoperatively and was maintained at 1 year ( p < 0.001). In an exploratory multivariable analysis, higher preoperative deviation was associated with lower odds of motor success (aOR 0.71; p = 0.024); however, this estimate should be interpreted cautiously because of the limited number of failure events. BLR and unilateral R&R yielded comparable motor and sensory outcomes at 1 year postoperatively in basic-type IXT. The exploratory association between higher preoperative deviation and lower motor success requires confirmation in larger cohorts.