Objectives: To compare the surgical efficacy and alignment stability of Bilateral Lateral
Rectus Recession (BLR) versus Unilateral Lateral Rectus Recession-Medial Rectus Resection
(RR) in the treatment of basic intermittent exotropia (IXT).
Methods: A prospective randomized interventional study was conducted on 40 patients with
basic IXT at Benha University Hospital. Participants were equally allocated into two groups:
BLR group (n=20) and RR group (n=20). Pre- and postoperative assessments included
measurement of near and far deviation angles using prism and alternate cover test, stereopsis
evaluation, and visual acuity. Follow-ups were conducted at 1, 3, and 6 months postoperatively.
Surgical success was defined as alignment within 10 prism diopters (PD) of orthophoria.
Results: Both groups demonstrated significant reductions in near and far deviation from
baseline at all follow-up points (P < 0.001). At 6 months, the RR group showed significantly
lower median near deviation (0 PD [range -10 to 20]) compared to the BLR group (7 PD [range
-10 to 30], P = 0.028). Far deviation was also significantly lower in the RR group (0 PD vs. 9
PD, P = 0.041). Surgical success was achieved in 70% of the RR group and 65% of the BLR
group (P = 0.361). Multivariate regression identified the RR technique as a significant predictor
of improved far deviation at 6 months (B = -6.624, P = 0.038).