Abstract
Purpose
To report the surgical outcomes of 24 patients undergoing single-staged three horizontal muscles squint surgery for extra-large angle exotropia.
Patients and methods
Prospective case series of 24 consecutive patients with primary exotropia >60 prism diopters (PD) at distant and underwent single-staged three horizontal muscles squint surgery from 2003 to 2006. Surgery consisted of bilateral lateral rectus recession of 9.0 mm for 50 PD exotropic correction. For every 5 PD remaining angle exceeding 50 PD, we additionally performed 1.0 mm of unilateral medial rectus resection. The mean follow-up period was 15.8 months (range 6.0–38.0 months; SD 9.5 months).
Results
The mean age at surgery was 31.2 years old (range 7–78 years old, SD 18.2 years old). The mean distant preoperative deviation was 71.3 PD (range 60–85 PD, SD 7.7 PD). No limitation of eye movement or diplopia was found. The success rate was higher in the intermittent group (88.2%) than the constant group (42.9%) (P=0.02) and in cases with preoperative deviation of <80 PD (84.2%) compared with those with deviation ⩾80 PD (40.0%) (P=0.042).
Conclusion
Measurement of preoperative deviation and the surgery for extra-large angle exotropia made management of this condition difficult. Single-staged three horizontal muscles squint surgery can be one of the options. Further researches on management of exotropia of >80 PD are warranted.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Scatterfield D, Keltner JL, Morrison TL . Psychosocial aspects of strabismus study. Arch Ophthalmol 1993; 111: 1100–1104.
Olitsky SE, Sudesh S, Graziano A, Hamblen J, Brooks SE, Shaha SH . The negative psychosocial impact of strabismus in adults. J AAPOS 1999; 3 (4): 209–211.
Burke JP, Leach CM, Davis H . Psychosocial implications of strabismus surgery in adults. J Pediatr Ophthalmol Strabismus 1997; 34: 159–164.
Ekdawi NS, Nusz KJ, Diehl NN, Mohney BG . Postoperative outcomes in children with intermittent exotropia from a population-based cohort. J AAPOS 2009; 13: 4–7.
Morris RJ, Scott WE, Dickey CF . Fusion after surgical alignment of longstanding strabismus in adults. Ophthalmology 1993; 100: 135.
Kushner BJ, Morton GV . Postoperative binocularity in adults with longstanding strabismus. Ophthalmology 1992; 99: 316–319.
Schwartz RL, Calhoun JH . Surgery of large angle exotropia. J Pediatr Ophthalmol Strabismus 1980; 17 (6): 359–363.
Guibor G . The surgical treatment of exotropia resulting from anterior intranuclear ophthalmoplegia. AJO 1950; 33: 1840.
Jampolsky A . Surgical management of exotropia. AJO 1958; 45: 646.
Rayner JW, Jampolsky A . Management of adult patients with large angle amblyopic exotropia. Ann Ophthalmol 1973; 5 (1): 95–99.
Liver-Rallatos G, Gunton KB, Calhoun JH . Surgical results in large angle exotropia. J AAPOS 2002; 6 (2): 77–80.
Currie ZI, Shipman T, Burke JP . Surgical correction of large angle exotropia in adults. Eye 2003; 17 (3): 334–339.
Pineles SL, Rosenbaum AL, Demer JL . Decreased postoperative drift in intermittent exotropia associated with A and V patterns. J AAPOS 2009; 13: 127–131.
Berland JE, Wilson ME, Saunders RA . Results of large (8–9 mm) bilateral lateral rectus recession for exotropia. Binocular Vis Strabismus Q 1998; 13: 97–104.
Wu HX, Sun J, Xia X, Xu L, Xu X . Binocular status after surgery for constant and intermittent exotropia. AJO 2006; 142 (5): 822–826.
Owens PL, Strominger MB, Rubin PA, Veronneau-Troutman S . Large angle exotropia corrected by intraoperative botulinum toxin A and monocular recession resection surgery. J AAPOS 1998; 2 (3): 144–146.
Velez G . Surgical treatment of exotropia with poor vision. Strabismus II. Proceedings of the Fourth Meeting of the International Strabismological Association 1984, pp 263–267.
Azar RF . Surgical management of exotropia exceeding 70 prism diopters. Ann Ophthalmol 1971; 3 (2): 159–166.
Morris RJ, Luff A . Adjustable sutures in squint surgery. Br J Ophthalmol 1992; 76: 560–562.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Lau, F., Fan, D., Yip, W. et al. Surgical outcome of single-staged three horizontal muscles squint surgery for extra-large angle exotropia. Eye 24, 1171–1176 (2010). https://doi.org/10.1038/eye.2010.5
Received:
Revised:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/eye.2010.5
Keywords
This article is cited by
-
Unilateral surgery for pediatric sensory exotropia: clinical characteristics and surgical results
BMC Ophthalmology (2022)
-
Is single-stage two-muscle surgery of 7–11 mm enough for large-angle exotropia?
International Ophthalmology (2022)
-
Long-term outcomes of three-muscles surgery for very large-angle constant exotropia (≥5 years of follow-up)
Eye (2021)
-
Surgical results and factors affecting outcome in adult patients with sensory exotropia
Eye (2018)