Slanted lateral rectus recession for exotropia with convergence weakness

Objective: To evaluate the efficacy of slanted recession of the lateral rec tus (LR) muscle for exotropia (XT) with convergence weakness. Design: Predesigned, nonrandomized, comparative trial. Participants: Twelve study patients and six control subjects with XT greate r at near than at distance by greater than or equal to 10 prism diopters (P D), intervention: Twelve consecutive patients underwent slanted LR recession, a nd six consecutive control subjects underwent standard LR recession. Main Outcome Measures: Between-groups comparison of the postoperative ocula r alignment at distance and near, and the difference between them, as well as the stereopsis, Results: Slanted LR recession reduced the XT to <8 PD in all patients at di stance and in 11/12 patients at near. Additionally, the mean difference bet ween the distance and near exodeviation was reduced from 14 +/- 4.5 PD preo peratively to 2.9 +/- 2.4 PD postoperatively, All patients in the control g roup demonstrated postoperative deviations of <8 PD at distance, but all ha d residual exodeviations >8 PD at near. Three of the study patients gained gross stereopsis postoperatively. Conclusions: Slanted recession of the LR is superior to standard recession in reducing both distance and near XT and in collapsing the difference betw een them. This technique may also have a positive impact on gross stereopsi s.