Dr Kushner1 reports favorable results in bilateral recession of the lateral rectus for intermittent exotropia by targeting the quantity of deviation uncovered by using targets outside a window (at 0.25 miles) and/or patching over one eye for 1 hour. His high percentage of satisfactory results from initial surgery is to be congratulated, but I am puzzled by an observation concerning his study. In both the control series (treated by conventional quantities of surgery for exotropia measured with targets at 6 m) and the study group (those treated for the larger angle of deviation found on retesting with 0.25-mile targets and/or after 1 hour of patching) he reports only 1 overcorrection at 1 year in both groups. This overcorrection rate is low when compared with the 6% to 20% rate reported in other series, including my own.2,3 The monofixation syndrome has been found in 5% to 10% of previous series and is usually a small motor angle esotropia with peripheral fusion, but poor stereoacuity.3- 5 Dr Kushner's report does not include any mention of this syndrome as a result of surgical treatment for his series so perhaps he did not encounter these overcorrections.
Ing MR. Intermittent Exotropia: Far Distance Target for Surgical Dosage. Arch Ophthalmol. 1998;116(11):1550-1551. doi: