Single stage Large LR recession with or without MR resection and its motor outcomes in Concomitant Exotropia

Abstract

Exotropia is a manifest outward deviation of the visual axes, which is either constantly or intermittently present. Untreated, poorly controlled intermittent exotropia later progresses to constant exotropia. Sensory exotropia is unilateral divergent misalignment of the eyes, resulting from loss of vision or long-standing poor vision in an eye. In sensory exotropia the angles are characteristically large, ranging from 30 to 100 prism dioptres (PD) and increases gradually over time as long as the cause of visual deficit remains active. Treatment is directed to re-establish the normal ocular alignment and binocular vision[1]. The preferred treatment for manifest exotropia is surgery[2]. Large angle constant exotropia negatively impacts the way the patients see themselves and are perceived by others. The benefits of surgical treatment of exotropia in adults is well proven, both psychologically and visually. The surgical treatment for largeangle exotropia has been a subject of sufficient debate. A variety of surgical plans have been described including two, three or four horizontal rectus muscles recession and resections with or without adjustable suture technique.[3] In more recent studies, the management of large-angle exotropia falls into two surgical approaches. Large bilateral lateral rectus recession is done when the acuity is good in each eye and indicated for true divergent excess type. For basic exodeviation R-R procedure is done popularly. Before embarking on surgical plan we do post occlusion test and identify the clinical type. If one eye is amblyopic, a maximal or supramaximal unilateral recess- resect procedure is performed. Records of previous studies have shown that monocular surgery had shown good results for exotropia of < 60 PD. But for exotropia of > 60 PD, monocular surgery was not so effective (4). In previous studies mild to moderate LR recessions were described but our study involves maximum recession on LR. In previous studies large LR recessions were reported to have complications like Lid changes and palpebral aperture widening. This study was done to evaluate the outcome of single stage, unilateral large LR recession with or without MR resection for constant exotropia