Comparative Evaluation of Unilateral Recession-Plication Versus Bilateral Three-Muscle Surgery for Large-Angle...

Area of Science:

• Ophthalmology
• Strabismus Surgery
• Pediatric Ophthalmology

Background:

• Large-angle exotropia presents a significant challenge in strabismus management.
• Surgical correction aims to restore binocular vision and improve cosmetic appearance.
• Traditional three-muscle surgery is often employed, but less invasive options are being explored.

Purpose of the Study:

• To compare the efficacy of unilateral recession-plication (two-muscle surgery) versus bilateral three-muscle surgery for large-angle exotropia.
• To evaluate ocular alignment, motor outcomes, and patient-reported quality of life.

Main Methods:

• A prospective, comparative study included 66 patients with large-angle exotropia (50-65 PD).
• Patients were divided into a two-muscle group (unilateral LR recession and MR plication) and a three-muscle group (bilateral LR recession and MR resection).
• The Adult Strabismus-20 (AS-20) questionnaire assessed outcomes pre- and post-operatively.

Main Results:

• Mean postoperative deviations were comparable: 9.29 ± 3.16 PD (two-muscle) vs. 8.44 ± 3.54 PD (three-muscle).
• Successful motor outcomes were achieved in 73.53% (two-muscle) and 75% (three-muscle) of patients.
• Both surgical approaches led to significant improvements in AS-20 scores with similar ocular motility limitations.

Conclusions:

• Unilateral recession-plication (two-muscle surgery) is an effective alternative for large-angle exotropia (up to 65 PD).
• It provides comparable motor outcomes and functional results to traditional three-muscle surgery.
• This approach offers a viable option with similar efficacy and limitations.