AIM: To compare the effectiveness of unilateral lateral rectus recession-medial rectus resection(RR))and lateral rectus recession-medial rectus plication(RP)in the treatment of exotropia.

METHODS: Evidence-based medicine research. A systematic database search was conducted Medline, Embase, Web of Science, the Cochrane Register of Controlled Trials and so on from August 2011 to August 2021. Related studies meeting the inclusion criteria were included in our study. The main outcome measures were as follows: success rate and postoperative deviation. Mean difference(MD)and odds ratio(OR)with 95% confidence interval(CI)were statistical analyzed as measurement data and continuous variables statistics.

RESULTS: A total of two randomized controlled studies and five retrospective studies were included. The Meta-analysis results showed that the success rate of surgery was similar for RP group compared with RR group(OR=0.65, 95%CI:0.39-1.07, P=0.09). There was no difference in the incidence of poor postoperative prognosis of the two groups(the undercorrection and overcorrection rates)(OR=1.59; 95%CI: 0.92-2.74, P=0.10; OR=4.43; 95%CI: 0.69-28.18, P=0.12). There were no significant differences in postoperative deviation and the amount of external oblique drift(MD=0.75, 95%CI: -0.27-1.76, P=0.15; MD=-0.34, 95%CI: -1.30-0.63, P=0.50).

CONCLUSION: The success rate of RP and RR surgery is close to the incidence of poor postoperative prognosis, moreover, there was no significant difference between the deviation and the amount of external oblique drift after the two surgeries, RP is an effective surgical procedure for the treatment of exotropia.