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Bilateral medial rectus resection for primary large-angle exotropia.

BACKGROUND: Surgical treatments for large-angle exotropia include bilateral lateral rectus recession, recession-resection procedures, and three- and four-muscle surgery. Undercorrection and limitation of abduction are common complications of these procedures. This study reports the results of bilateral medial rectus resection as a first procedure for primary large-angle exotropia.

METHODS: The medical records of patients who underwent bilateral medial rectus resection for angles ≥60Δ in the period from 2006 till 2016 with a minimum follow-up period of 6 months were reviewed retrospectively. The amount of resection ranged from 8 mm to 12 mm according to the preoperative angle. Success was defined as a final outcome within the range of 8Δ of esotropia to 10Δ of exotropia.

RESULTS: A total of 64 patients were included, in whom angles ranged from 60Δ to 140Δ . The overall success rate was 77%, and there was no significant difference in success rate between classes of smaller and larger angles. Limitation of abduction was seen in first postoperative week. At 6 months' follow-up 64% of eyes had no limitation of abduction.

CONCLUSIONS: In our patient cohort bilateral medial rectus resection successfully corrected large-angle exotropia of up to 140Δ , with results comparable to three- and four-muscle procedures. It has the advantage of not causing significant abduction deficits, even with resections up to 12 mm.

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