الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Large-angle exodeviations present many challenges to patients and physicians. Exodeviation impact negatively on the way patients see themselves and are perceived by others. The benefits of surgical treatment of exodeviation in adults are well proven, by improving a patient’s psychosocial functioning and also restoring binocular vision in many cases. In this study, we aimed at comparing the surgical outcomes of three muscles surgery versus four muscles surgery for large angle constant exotropia with distance angle ≥70 prism diopters, regarding the motor alignment, sensory outcomes. This study was conducted on 20 patients divided into two groups: group 1: included 12 patients had 3-muscles surgery (bilateral lateral rectus recession and unilateral medial rectus resection in non-dominant eye). group 2: included 8 patients had 4-muscles surgery (bilateral lateral rectus recession and bilateral medial rectus resection). All patients underwent complete ophthalmic examination before surgery, including visual acuity assessment, refraction, anterior segment examination, fundus examination and strabismic examination, both motor and sensory. Motor assessment included measurement of the angle of deviation at distance (6 meters) and near (33cm) with spectacles correction, using the Prolonged alternate prism cover test. Sensory assessment included Bagolini striated glasses to test fusion and near stereopsis assessed by Lang and TNO tests. Those measures were done before and after surgery. Follow up of the patients was done in the postoperative period for 6 months. Pre–operatively, the mean angle of deviation in three muscles group was 76.58 PD and for four muscles group was 78.62 PD. The difference between both groups was statistically insignificant. Successful motor outcome in the last follow up was achieved in 7 of 12 patients [58.3%] in the three- muscles group and in 7 of 8 patients [87.5%] in the four- muscles group. The maximum lateral rectus recession was done 9 mm in both three muscles and four muscles surgery. The medial rectus resection ranged from 4-6.5 mm for 3 muscles surgery and ranged from 4.5-8 mm for 4 muscles surgery. All patients were negative fusion assessed by Bagolini striated glasses and negative binocular vision assessed by Lang and TNO tests. In our study, the fusion in both groups improved from the 1st week post-operative 75% for three muscles group and 62.5% and four muscles group. The percentage increased in both groups in the 3rd month to 83.3 for group 1 and 87.5 for group 2. This percentage decreased in group 1 in the last follow up and was constant in group 2 till the last follow up. The binocular vision by TNO test started restoration from the 1st month in three muscles group and from the 3rd month in four muscles group. It was positive in 50% in group 1 where five cases achieved of 240 seconds of arc and one case achieved stereoscopic angle of 480 seconds of arc at the last follow up. In group 2, 71.4% were positive at the last follow up where half of them achieved binocularity of 240 seconds of an arc and the other half achieved 480 seconds of an arc. The difference between both groups was statistically insignificant (p=0.322). In our study, seven patients (58.3%) of the twelve patients in group 1 (three muscles) had effective motor alignment at the last visit, with 6 patients regained binocular function at the last follow up. In group 2 (four muscles), seven patients (87.5%) had their alignment issues resolved, with 6 patients regained binocular function at the last follow up. In conclusion, four horizontal muscles surgery is superior to three horizontal muscles surgery as a single stage procedure regarding to motor and sensory outcomes.