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Nikhil N. Batra, Noopur N. Batra, Mark J. Greenwald; Bilateral 8-mm Medial Rectus Muscle Resection As Primary Surgery For Large Angle Exotropia. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6338.
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Large angle exodeviation in patients is often undercorrected when primary surgery consists of maximal bilateral lateral rectus muscle recession. Bilateral medial rectus resection may be controversial as primary surgery for such deviations and is underreported in current literature. We reviewed recent experience in treating large angle exodeviations uniformly with bilateral 8-mm medial rectus muscle resection as the primary procedure.
Retrospective medical record review.
Thirteen patients (6 male, 7 female; age range 6-68, mean 23) with no history of prior surgery for exodeviation underwent bilateral 8-mm medial rectus muscle resection by a single surgeon (MJG) from 2009 to 2011. Preoperative exodeviation ranged from 40 to 70 prism diopters, mean 55. Postoperative exodeviation ranged from 0 to 40 prism diopters, mean 18. Change in deviation ranged from 15 to 55 prism diopters, mean 37. There were no overcorrections or complications. To date no patient has elected to have further surgery for residual exodeviation.
Bilateral 8-mm medial rectus resection is a safe, effective, and appropriate initial procedure for exodeviation measuring 40 prism diopters or more in visually mature persons, eliminating the problem or producing alignment acceptable to the patient in most cases, with no significant adverse effects in a small series. Residual exodeviation is amenable to further treatment with moderate recession of one or both lateral rectus muscles. To our knowledge this is the first and largest reported series of patients undergoing bilateral medial rectus resections as a primary procedure for large angle exotropia greater than 40 prism diopters.
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