Bilateral lateral rectus muscle recession with medial rectus pulley fixation for divergence excess intermittent exotropia with high AC/A ratio.

PURPOSE: To evaluate the efficacy of bilateral rectus muscle recession with medial rectus pulley posterior fixation for patients with intermittent exotropia with high AC/A ratio.

METHODS: This study included consecutive patients with exodeviation ≥10(Δ) greater at distance than at near fixation and with a high AC/A ratio who underwent bilateral lateral rectus muscle recession to eliminate the exotropia at distance and pulley posterior suturing on both medial rectus muscles to prevent consecutive esotropia at near fixation. A successful outcome was defined as near or distance angle of exodeviation ≤8(Δ) and a ≤10(Δ) difference between the two.

RESULTS: A total of 7 patients were enrolled. Of these, 5 (71%) achieved successful results. One patient required bifocal correction for postoperative esodeviation at near fixation.

CONCLUSIONS: In this case series, most patients with intermittent exotropia and a high AC/A ratio were successfully treated with bilateral lateral rectus muscle recession combined with medial rectus pulley posterior fixation.