This article was discussed as part of our paediatric team journal club in Auckland in last month. Many years ago we’d tried to set up a trial for basic IDEX patients with random allocation of surgery to be bilateral rectus recession (BLRc) or unilateral R&R with the majority of our surgeons routinely performing BLRc.

Our project didn’t get off the ground for various reasons. There was also a difference in opinion as to who should do the surgery and how much surgery as surgeons have their own tables of surgical procedures as to how many millimetres for an angle of deviation in their hands and also depending on where you take measurements from. There was also a nervousness regarding allocating into R & R group.

Nice to see an article with high number of patients, 123 from 197 in original 3 year study, having 8 year follow up with similar number for both procedures and very small percentage withdrawn as study progressed. 9-10% withdrawn in year 8 cohort.

No difference in initial results from either procedure but ‘suggests’ R & R  be the better option for longer term stability. I was thinking 35 sites and multiple surgeons – might be like comparing apple to oranges as technique and amount of surgery variable.

Kushner 1998 reference hypothesized that restrictive effect created by MR resection tethers the eye in place, decreasing the tendency for an outward and recurrence drift which this study seems to support.

Our surgeons are currently doing BLRc and did suggest they may not in the future.