title: Large-angle strabismus: can a single surgical procedure achieve a successful outcome?
abstract: OBJECTIVE
  Large-angle strabismus is a gray zone for surgeons with various advocates for one, two-, three-, or even four-muscle surgeries. Very frequently, reoperations are required in these cases in order to achieve a successful outcome. In this article, the authors evaluate the outcome of concomitant large-angle strabismus after a single surgical procedure.
  
  
  METHODS
  A retrospective analysis of all operated cases of concomitant large-angle strabismus (50 prism diopters or more) during a 1.5-year period was performed from patient's case files. A successful outcome of surgery was defined as deviation within 10 prism diopters of orthophoria/tropia for both distance and near.
  
  
  RESULTS
  Fifty patients met the inclusion criteria. The overall success rate was 60%, with the esotropia group having a higher success rate (68.75%) than the exotropia group (44.45%). Ten patients underwent recess-resect procedure, 20 had bimedial rectus recession, and 3 had bilateral lateral rectus recession, while 17 patients had surgery on 3 horizontal rectus muscles. Thirty-three patients had two-muscle surgery with a success rate of 57.58%, while 17 patients had three-muscle surgery with a success rate of 64.71%, the difference being statistically insignificant. There was no statistically significant difference between the various age groups analyzed for overall success rate, suggesting that age group is not a factor for positive outcome in large-angle strabismus surgery. A total of 12 patients were amblyopic at the time of strabismus surgery and they had a success rate of 33.33%, which was much poorer than the success rate (68.42%) of the remaining 38 patients who did not have amblyopia at the time of surgery.
  
  
  CONCLUSIONS
  A good surgical outcome can be obtained in large-angle strabismus with a single surgical procedure, though a randomized controlled study needs to be done to establish whether three-muscle surgeries give better results than two-muscle surgeries.
authors.affiliation: Department of Ophthalmology, Christian Medical College & Hospital, Ludhiana, India. ashusatish.thomas@gmail.com
authors.forename: Satish
authors.initials: S
authors.lastname: Thomas
authors.forename: Sujata
authors.initials: S
authors.lastname: Guha
mesh_terms: D000368:Aged; D000550:Amblyopia / Q000209:etiology / Q000601:surgery; D004948:Esotropia / Q000601:surgery; D005099:Exotropia / Q000601:surgery; D005260:Female; D006801:Humans; D009801:Oculomotor Muscles / Q000601:surgery; D013508:Ophthalmologic Surgical Procedures; D012189:Retrospective Studies; D013285:Strabismus / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome