title: Outcomes of 3 or 4 Horizontal Muscles Surgery in Large-Angle Exotropia.
abstract: OBJECTIVE
  To evaluate motor and sensory outcomes of 3 or 4 horizontal muscles surgery for the treatment of large-angle exotropia and to evaluate factors influencing the success rate and the relationship between initial postoperative and final motor outcomes.
  
  
  METHODS
  A retrospective analytical study.
  
  
  METHODS
  Medical records of patients with primary large-angle exotropia [>50 prism diopters (PD)] who had 3 or 4 horizontal muscles surgery were reviewed. Motor outcomes were categorized as successful (esotropia 1-8 PD, orthotropia or exotropia 1-10 PD), acceptable (exotropia 11-20 PD), and poor (esotropia >8 PD or exotropia >20 PD). Results were evaluated only at the last follow-up visit if patients were followed up for less than 2 years. Those who were followed up for more than 2 years were evaluated at both the 2-year and final follow-up visits. Factors influencing the success rate and the relationship between initial postoperative and final motor outcomes were analyzed.
  
  
  RESULTS
  A total of 36 patients were enrolled in this study. The median follow-up time was 18 months (range, 3-60 months). The success rate was 69% at the last follow-up and 75% at the follow-up at 2 years, respectively. Stereopsis improved in 43% at the last follow-up and 56% at 2 years. Initial postoperative deviation was found to correlate with the success rate at the last follow-up (P = 0.018). Initial postoperative overcorrection of 8 to 14 PD had the highest possibility of gaining successful final motor outcomes.
  
  
  CONCLUSIONS
  Three or 4 horizontal muscles surgery in large-angle exotropia can achieve successful motor outcomes and improve stereopsis. Surgeons should aim for initial overcorrection in order to maximize long-term success.
authors.affiliation: From the *Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University; and †Rutnin Eye Hospital, Bangkok, Thailand.
authors.forename: Tassanee
authors.initials: T
authors.lastname: Raiyawa
authors.forename: Supharat
authors.initials: S
authors.lastname: Jariyakosol
authors.forename: Pokpong
authors.initials: P
authors.lastname: Praneeprachachon
authors.forename: Parnchat
authors.initials: P
authors.lastname: Pukrushpan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003867:Depth Perception / Q000502:physiology; D005099:Exotropia / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures; D012189:Retrospective Studies; D015348:Vision, Binocular / Q000502:physiology; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult