Comparing Lateral Rectus Recession and Bupivacaine Injection of Medial Rectus With Conventional Recession–Resection in Moderate-Angle Intermittent Exotropia Publisher Pubmed



Mirmohammadsadeghi A ; Razavi A ; Akbari MR ; Sadeghi M ; Masoomian B ; Asadigandomani H
Source: Graefe's Archive for Clinical and Experimental Ophthalmology Published:2026

Abstract

Purpose: To compare the clinical outcomes of lateral rectus (LR) recession and bupivacaine injection of medial rectus (MR) with conventional recession–resection (R&R) surgery in patients with moderate-angle intermittent exotropia. Methods: This prospective study included 105 patients with intermittent exotropia between 25 and 30 prism diopters (PD), treated at a single tertiary center. Patients were assigned to either bupivacaine injection of MR combined with LR recession (n = 53) or standard R&R surgery (n = 52). Follow-up evaluations were conducted at 1, 6, 12, 18, and 24 months postoperatively. The primary outcome was surgical success, defined as exotropia ≤ 10 PD or esotropia ≤ 5 PD in the primary position. Secondary outcomes included postoperative angle changes, need for prism, and complication rates. Results: The bupivacaine group demonstrated higher success rates than the R&R group across all follow-up intervals; however, the differences were not statistically significant (all P-values > 0.05). The R&R group had significantly higher overcorrection rates (P-value < 0.001), while none of the bupivacaine patients were overcorrected. The bupivacaine group consistently showed an undercorrection rate of 20.7%, which was significantly higher than the 7.7% rate in the R&R group at all follow-up time points (P-value < 0.001). No serious complications were reported in either group at all follow-up time points. Conclusions: Adding bupivacaine injection of MR to LR recession appears to be a safe, effective, and minimally invasive alternative to traditional R&R surgery for moderate-angle intermittent exotropia. It is associated with favorable outcomes, low complication rates, and no overcorrection. Further randomized, controlled trials with extended follow-up are necessary to confirm these findings. © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2026.