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Surgical case series reveals high cosmetic alignment after two-muscle surgery in large angle exotropia, indicating that limiting correction to two muscles reduces surgical morbidity.
In summary, 22 patients have been presented who have undergone lateral rectus recessions ranging from 8 to 14 millimeters. The overall cosmetic success rate (plus or minus 15 diopters of orthophoria) was 77%. Eight of these patients had unilateral recession-resection procedures. Surgically created incomitance ranged from 3 millimeters to 6 millimeters and correlated only poorly with the amount of surgery performed. None of the patients complained of cosmetic or symptomatic effects of the lateral incomitancy induced. We have restricted surgery of the large angle exotrope to a single, two-muscle procedure, thereby decreasing patient morbidity. It is therefore our recommendation that surgery for large angle exotropia be restricted to two horizontal muscles.
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Schwartz et al. (1980) studied this question.
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