Outcomes for maximal bilateral lateral rectus recession in large-angle exotropia

Surgical treatment for large-angle exotropia can be challenging. The aim of this study was to evaluate short-term surgical outcomes of patients with large-angle exotropia (≥50^Δ) undergoing maximal bilateral lateral rectus muscle recession of 10 mm.

This was a retrospective study of consecutive patients at our institution who underwent maximal bilateral lateral rectus muscle recession for exodeviation ≥50^Δ from January 1, 2008, to July 22, 2022. We subdivided the cohort into large-angle exotropia (largest amount of exodeviation at near and/or distance ≥50^Δ and <65^Δ) and very large-angle exotropia (largest exodeviation ≥65^Δ). Patients with a history of prior eye muscle surgery, neurologic deficits, and three- or four-muscle surgery were excluded.

A total of 22 patients were included. Mean preoperative exodeviation at distance was 51.9^Δ in the large-angle group and 67.5^Δ in the very-large-angle group (P = 0.001). Outcomes for the large-angle and very-large angle groups were, respectively, as follows: mean follow-up, 31.1 weeks and 11.8 weeks (P = 0.97); success, 75.0% and 16.7% (P = 0.02); undercorrection rates, 18.7% and 83.3% (P = 0.01); and mean postoperative exodeviation at distance, 3.7^Δ ± 6.3^Δ and 28.0^Δ ± 13.5^Δ (P = 0.001).

Our study identified good surgical outcomes (75%) with maximal bilateral lateral rectus muscle recession of 10 mm in treating patients with large-angle exotropia between 50^Δ and <65^Δ. Other surgical techniques such as recession-resection and three- or four-muscle surgery may result in better outcomes when treating patients with exotropia ≥65^Δ.