title: Outcome of a surgical treatment protocol for late consecutive exotropia following bilateral medial rectus recession for esotropia.
abstract: OBJECTIVE
  To describe a specific protocol for the surgical treatment of Late Consecutive Exotropia (LCXT) following bilateral medial rectus (MR) recessions, and to report the results of surgery, performed according to this protocol, in a series of 119 children followed 6 months to 15 years after surgery for consecutive exotropia.
  
  
  METHODS
  The senior author (JLM) performed a retrospective chart review of 15 years of his experience following a specific protocol for the surgical treatment of LCXT. In individual cases, following this protocol led to recessions of the overacting inferior oblique (IO) with anterior transposition if dissociated vertical deviation (DVD) was also present, weakening of the overacting superior oblique (SO) with simultaneous 10 mm recessions of the superior rectus (SR) with 3 mm of nasal transposition (to ameliorate DVD which might be aggravated by SO tenotomies), graded recessions of one lateral rectus (LR) 7.0 to 8.5 mm if the distance deviation was equal to or less than 23 prism diopters (PD) of XT, and advancement of one previously recessed MR to the insertion if the distance deviation was equal to or greater than 24 PD XT.
  
  
  RESULTS
  "Success" was defined as 8 PD ET to 6 PD XT, with both distance and near fixation. Among 14 patients receiving SR recessions, SO tenotomies, and recession of one LR, 12 of the 14 were "successes" at 6 months postop' and 10 of 14 at an average of 3 years postop'. Among 26 receiving advancement of one MR, "successes" were 23 of 26 at 6 months postop' and 20/26 at two years after surgery. Among 22 receiving IO recession with anterior transposition if DVD was present, "successes" were 18 of 22 at 6 months and 12 of 22 at 3.6 years. Among 57 receiving only recession of one LR, 53 of 57 were "successes" at 6 months postop' and 45 of 57 at 4 years postop'. The overall "success" rate for this protocol for these 119 patients was 89% at 6 months and 74% at 2 to 4 years postop'. Treatment of simultaneous IO overaction and LCXT was associated with the highest long term "failure" rate in this protocol.
  
  
  CONCLUSIONS
  This specific surgical protocol for treatment of late consecutive exotropia is reasonably safe and effective and comparable to the few other reported protocols of various surgical treatments for consecutive exotropia.
authors.affiliation: University of Texas Health Science Center and the Methodist Children's Hospital, San Antonio, Texas, USA.
authors.forename: James L
authors.initials: JL
authors.lastname: Mims
authors.forename: Robert C
authors.initials: RC
authors.lastname: Wood
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004948:Esotropia / Q000601:surgery*; D005099:Exotropia / Q000209:etiology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D009801:Oculomotor Muscles / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D015348:Vision, Binocular