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

Exotropia is a manifest outward deviation of the visual axes,which is either constantly or intermittently present. Untreated,poorly controlled intermittent exotropia later progresses toconstant exotropia.Sensory exotropia is unilateral divergent misalignment of theeyes, resulting from loss of vision or long-standing poor visionin an eye.In sensory exotropia the angles are characteristically large,ranging from 30 to 100 prism dioptres (PD) and increasesgradually over time as long as the cause of visual deficit remainsactive. Treatment is directed to re-establish the normal ocularalignment and binocular vision[1]. The preferred treatmentfor manifest exotropia is surgery[2]. Large angle constantexotropia negatively impacts the way the patients seethemselves and are perceived by others. The benefits of surgicaltreatment of exotropia in adults is well proven, bothpsychologically and visually. The surgical treatment for largeangle exotropia has been a subject of sufficient debate. Avariety of surgical plans have been described including two,three or four horizontal rectus muscles recession andresections with or without adjustable suture technique.[3] Inmore recent studies, the management of large-angle exotropiafalls into two surgical approaches.Large bilateral lateral rectus recession is done when the acuityis good in each eye and indicated for true divergent excesstype. For basic exodeviation R-R procedure is done popularly.Before embarking on surgical plan we do post occlusion testand identify the clinical type.If one eye is amblyopic, a maximal or supramaximal unilateralrecess- resect procedure is performed.Records of previous studies have shown that monocularsurgery had shown good results for exotropia of < 60 PD. Butfor exotropia of > 60 PD, monocular surgery was not so effective(4).In previous studies mild to moderate LR recessions weredescribed but our study involves maximum recession on LR.In previous studies large LR recessions were reported to havecomplications like Lid changes and palpebral aperturewidening.This study was done to evaluate the outcome of single stage,unilateral large LR recession with or without MR resection forconstant exotropia