Randomised controlled trial for large-angle exotropia surgery
Reviewed by Fiona Rowe

The purpose of this study was to investigate single eye, single setting surgical options to correct 80–90PD of exotropia with two options of muscle transplant and suture hang-back recession. There was retention of anatomical limits of 6mm resection for medial rectus and 9mm recession for lateral rectus muscles. This was a prospective randomised controlled trial with angles >60PD, over 18 years of age and no prior history of extraocular muscle surgery. Group 1 included medial rectus resection and transplant-aided lateral rectus recession of median 5mm. Group 2 included medial rectus resection with hang-back suture for lateral rectus recession of median 6mm. Ten subjects were allocated per group with median age of 27.5 years for group 1 and 26.0 years for group 2, preoperative deviation of 87.5PD for group 1 and 85.0PD for group 2, median postoperative abduction limitation of -0.50 for group 1, median surgery time of 38.5 minutes for group 1 and 30.5 minutes for group 1, and -1 for group 2, and net corrected postoperative angle of 81PD for groups 1 and 2. Each group attained 80% successful outcomes. The authors conclude that both procedures could address 60–90PD by one eye surgery. Hang-back procedures had surgical technical advantages and ease of procedure, and therefore were preferred.

A pilot randomised clinical trial comparing muscle transplant versus hang-back recession in extra-large angle exotropia.
Pujari A, Modaboyina S, Thangavel R, et al.
STRABISMUS
2023;31(3):159–65.