Comparative study of plication-recession versus resection-recession for intermittent exotropia

Purpose To compare the surgical outcomes of two different surgical techniques, resection and plication both in combination with recession, in basic intermittent exotropia. Methods In this prospective randomized trial, a total of 90 patients with basic intermittent exotropia were followed up pre- and post-operatively for at least 1 year in two treatment groups; 44 patients in the plication-recession (PR) group, 46 patients in the resection-recession (RR) group, and surgical outcomes were evaluated. Results There were no significant differences in average deviation angles between the PR and RR groups during the first postoperative week and first month. Over time, the PR group showed a more pronounced exo-drift beginning within the first month and continuing until the sixth month before stabilizing, whereas the RR group maintained significantly lower deviation angles at the 3 rd month, 6 th month and the 1-year follow-up. Consequently, the PR group experienced lower success rates at the 1st month, 6th month, and 1-year follow-ups, with final 1-year success rates of 55% for the PR group compared to 80% for the RR group. All 1-year failures in both groups resulted from under-correction. Conclusions Although the plication procedure has favorable outcomes in the short-term, significant exo-drift has caused suboptimal long-term outcomes.