Background: 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. Aim of Study: To evaluate the results of monocular super maximal recession and resection operations performed on the poorly seeing eye. Patients and Methods: The study was carried out in Ophthalmology Department, Tanta University Hospital included 30 patients had large angle sensory extropia (40 to 120 PD). We underwent full history taking, and required clinical ophthalmological and general examination. Operations and Follow-up: Lateral rectus recession ranged from 7 to 11mm and medial rectus resection ranged from 5 to 9mm. Postoperatively, follow-up was carried out after 1 week, 1, 3 and 6 months. Results: Post operative persistently narrowed palpebral fissure was observed in 4 patients (13.3%), while transient (for 3 months) limitation of abduction was observed in 4 patients (13.3%). Postoperative orthotropia occurred in 23 cases (76.7%) while residual exotropia was observed in 7 cases. After 6 months of follow-up recurrence occurred in 20%. The operation was considered totally successful in 18 patients (60%) who were with no residual exotropia, no recurrence, no persistent palpebral fissure narrowing, and no persistently limited abduction. Our patients' satisfaction had been obtained in 26 patients (86.7%). Conclusions and Recommendations: Monocular super maximal recession/resection operations on the affected eye could be a suitable decision in large angle sensory exotropia with acceptable rate of success and disfigurement and recurrence rates. More studies are recommended on larger numbers of patients and with longer period of follow-up. Also super maximal recession/resection operations can be tried on patients with large angle sensory esotropia.
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