title: Bilateral medial rectus resection for primary large-angle exotropia.
abstract: BACKGROUND
  Surgical treatments for large-angle exotropia include bilateral lateral rectus recession, recession-resection procedures, and three- and four-muscle surgery. Undercorrection and limitation of abduction are common complications of these procedures. This study reports the results of bilateral medial rectus resection as a first procedure for primary large-angle exotropia.
  
  
  METHODS
  The medical records of patients who underwent bilateral medial rectus resection for angles ≥60Δin the period from 2006 till 2016 with a minimum follow-up period of 6 months were reviewed retrospectively. The amount of resection ranged from 8 mm to 12 mm according to the preoperative angle. Success was defined as a final outcome within the range of 8Δof esotropia to 10Δof exotropia.
  
  
  RESULTS
  A total of 64 patients were included, in whom angles ranged from 60Δto 140Δ. The overall success rate was 77%, and there was no significant difference in success rate between classes of smaller and larger angles. Limitation of abduction was seen in first postoperative week. At 6 months' follow-up 64% of eyes had no limitation of abduction.
  
  
  CONCLUSIONS
  In our patient cohort bilateral medial rectus resection successfully corrected large-angle exotropia of up to 140Δ, with results comparable to three- and four-muscle procedures. It has the advantage of not causing significant abduction deficits, even with resections up to 12 mm.
authors.affiliation: University of Alexandria, Alexandria, Egypt. Electronic address: Elkamshoushy@gmail.com.
authors.forename: Amr A
authors.initials: AA
authors.lastname: ElKamshoushy
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005099:Exotropia / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D005133:Eye Movements / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000503:physiopathology / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D015348:Vision, Binocular; D055815:Young Adult