Evaluation of the Results of Supermaximal Monocular Recession-Resection Operations for Large-Angle Sensory Exotropia

Abstract
Background: In sensory exotropia with large distant angle (>40 PD) there is usually preference to operate on the poorly seeing eye to spare the sound eye.
Aim of Study: To evaluate the results of monocular super maximal recession and resection operations performed on the poorly seeing eye.
Patients and Methods: The study was carried out in Ophthalmology Department, Tanta University Hospital includ-ed 30 patients had large angle sensory extropia (40 to 120 PD). We underwent full history taking, and required clinical ophthalmological and general examination.
Operations and Follow-up: Lateral rectus recession ranged from 7 to 11mm and medial rectus resection ranged from 5 to 9mm. Postoperatively, follow-up was carried out after 1 week, 1, 3 and 6 months.
Results: Post operative persistently narrowed palpebral fissure was observed in 4 patients (13.3%), while transient (for 3 months) limitation of abduction was observed in 4 patients (13.3%). Postoperative orthotropia occurred in 23 cases (76.7%) while residual exotropia was observed in 7 cases. After 6 months of follow-up recurrence occurred in 20%. The operation was considered totally successful in 18 patients (60%) who were with no residual exotropia, no recurrence, no persistent palpebral fissure narrowing, and no persistently limited abduction. Our patients' satisfaction had been obtained in 26 patients (86.7%).
Conclusions and Recommendations: Monocular super maximal recession/resection operations on the affected eye could be a suitable decision in large angle sensory exotropia with acceptable rate of success and disfigurement and recur-rence rates. More studies are recommended on larger numbers of patients and with longer period of follow-up. Also super maximal recession/resection operations can be tried on patients with large angle sensory esotropia.