الفهرس 
Gross Anatomy of the extraocular Rectus MusclesOnly 14 pages are availabe for public view
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Abstract
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. However, this may involve supermaximal resection/recession operations on the recti muscles which may carry the risk of postoperative disfigurement and limitation of abduction. The present study was carried out in Ophthalmology Department of Tanta University Hospital between January 2017 and January 2018, on 30 patients (17 females and 13 males) aging 5 to 47 years (mean 26.0 + 12.3), with large angle sensory extropia (preoperative distant angle of deviation ranged from 40 to 120 PD with a mean of 62.33 + 20.457 PD) fulfilling the criteria of study inclusion. The aim was to evaluate the results of supermaximal recession and resection operations performed on the poorly seeing eye, sparing the dominant seeing eye in these patients. Full history taking (including the age at the time of operation, and etiology of visual loss), visual acuity and fundus examination of both eyes, post cycloplegic refraction of both eyes, examination of ocular motility, measurement of the angle of exodeviation by Hirschberg test, prism and cover test. General medical assessment of the patient to minimize the risks of operation and anesthesia was also done. Monocular supermaximal recession/resection operations were done for our patients according to their clinical situation and the distant angle of exodeviation. Lateral rectus recession ranged from 7 to 11 mm (mean 9.47 + 0.86) and medial rectus resection ranged from 5 to 9 mm (mean 6.07 + 0.64). Postoperatively, follow up was carried out on first day following the operation, after 1 week, after 1 month, after 3 months and after 6 months. During the follow up post operative persistently narrowed palpebral fissure was observed in 4 patients, while transient limitation of abduction was observed in 2 patients after one week, which disappeared within 3 months of follow up. Post operative orthotropia occurred in 23 cases (76.7%) with 2 cases of esotropia that improved within 3 months and residual exotropia was observed in 7 cases. During follow up, exotropia in 6 patients, out of these 7 patients, progressed again which could be considered as recurrence of exotropia (20% rate) while one case remained stationary. The age of the patient at operation was significantly positively correlated with patient’s age at exotropia onset and the duration of exotropia, as well as with the preoperative distant degree of exodeviation. The amount of lateral rectus recession showed a significantly positive correlation to the age of onset of exotropia, the age of the patient at operation, the duration of exotropia, the preoperative degree of exodeviation and the amount medial rectus resection. The operation was considered totally successful in 18 patients (60%). In these cases, the patient was satisfied with the result of operation, with no residual exotropia, no recurrence, no persistent palpebral fissure narrowing, and no persistently limited abduction. By considering operative success as a postoperative exodeviation 10 PD or less as in the protocol of this study, and as reported by other authors, (regardless of patients’ opinion or minimal disfigurements encountered), we could get an operative success rate in the present study in 23 patients out of 30 (76.7%) which is a good rate compared with similar works on these high degrees of preoperative exodeviation (40-120 PD). Our patients’ satisfaction has been obtained in 26 patients (86.7%) and was significantly associated with achievement of total success, absence of residual exotropia, and absence of exotropia recurrence. Patients’ satisfaction in our studied cases showed a non significant relationship with limited abduction, narrowed palpebral fissure or early postoperative misalignment. No cases complained of diplopia and no enophthalmos has been observed in studied patients.