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

BACKGROUND 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(Delta)) undergoing maximal bilateral lateral rectus muscle recession of 10 mm. METHODS This was a retrospective study of consecutive patients at our institution who underwent maximal bilateral lateral rectus muscle recession for exodeviation >= 50(Delta) 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(Delta) and <65(Delta)) and very large-angle exotropia (largest exodeviation >= 65(Delta)). Patients with a history of prior eye muscle surgery, neurologic deficits, and three- or four -muscle surgery were excluded. RESULTS A total of 22 patients were included. Mean preoperative exodeviation at distance was 51.9(Delta) in the large -angle group and 67.5(Delta) 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(Delta) +/- 6.3(Delta) and 28.0(Delta) +/- 13.5(Delta) (P = 0.001). CONCLUSIONS 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(Delta) and <65(Delta). Other surgical techniques such as recession -resection and three- or fourmuscle surgery may result in better outcomes when treating patients with exotropia >= 65(Delta). ( J AAPOS 2024;28:103816)