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New research · Ophthalmology
Journal of pediatric ophthalmology and strabismus · 2d
StudyJournal of pediatric ophthalmology and strabismus · 2026

Comparative Evaluation of Unilateral Recession-Plication Versus Bilateral Three-Muscle Surgery for Large-Angle Exotropia.

Kamlesh Anand, Vaibhav Nagpal, Paromita Dutta … Kartika Anand
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OphthalmologyStudy

Two-muscle surgery matched three-muscle surgery for large-angle exotropia correction.

Comparative Evaluation of Unilateral Recession-Plication Versus Bilateral Three-Muscle Surgery for Large-Angle Exotropia.

Kamlesh Anand … Kartika Anand
Journal of pediatric ophthalmology and strabismus · 2026
Purpose

To evaluate and compare unilateral recession-plication versus bilateral three-muscle surgery for large-angle exotropia.

Methods

A prospective interventional non-randomized comparative study was conducted involving 66 patients with large-angle exotropia, with deviation between 50 and 65 prism diopters (prism diopters).

n = 66 patients
Results

in the two-muscle group, eye alignment reached the success target after surgery

73.53%
Two-muscle
75%
Three-muscle
More results

The mean preoperative deviation for distance in the two-muscle (n = 34) and three-muscle (n = 32) groups was 56.53 ± 5.62 and 54.89 ± 5.83 prism diopters, respectively ( P = .849).

More results

The mean postoperative deviation was 9.29 ± 3.16 prism diopters in the two-muscle group and 8.44 ± 3.54 prism diopters in the three-muscle group at the 6-month postoperative visit ( P = .303).

Both groups showed a statistically significant improvement in AS-20 scores.

“
Conclusion

In patients with large-angle exotropia up to 65 prism diopters, two-muscle surgery achieved acceptable ocular alignment with no statistically significant difference in motor outcomes or motility limitations compared to traditional three-muscle surgery.

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