Surgical results in large-angle exotropia.

Purpose: This study examines the surgical results of correcting large angle exodeviations in adults who may lack bifixation. The expected results in adults are not to achieve improved fusion but, rather, to construct the alignment.

Methods: A retrospective chart review was conducted of all patients with comitant exodeviation greater than 35 Delta examined and treated by 1 pediatric ophthalmologist between January 1994 and May 1999. Any patients with large A or V patterns, nystagmus, history of botulinum toxin injections for strabismus, paralytic or mechanical cause for strabismus, or use of adjustable sutures were excluded. Charts were reviewed for postoperative alignment. Postoperative results were separated into 3 categories: exodeviation greater than 10 Delta, successful outcome (esotropia<10 Delta, orthotropia, or exodeviation <10 Delta), or esotropia greater than 10 Delta.

Results: Sixty-three patients met the inclusion criteria. Their median age at the time of surgery was 18, with a standard deviation of 20. The majority of them had intermittent exotropia that had deteriorated into constant exotropia. Fifty-two patients had bilateral lateral rectus recessions, and 11 patients had recess/resect procedures. Sixty-two percent (39 of 63) had successful outcomes overall. Only 2 patients had overcorrection (esotropia>10 Delta). In patients with deviations greater than 50 Delta, 82% (9 of 11) were undercorrected (exodeviation >10 Delta).

Conclusions: Large-angle exodeviations can be successfully approached with bilateral lateral rectus recessions or recess/resect procedures in preoperative deviations up to and including 50 Delta with a success rate of 71%. In larger deviations, 2-muscle surgery was not as successful (18%, or 2 of 11).