{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T05:44:13Z","timestamp":1786167853874,"version":"build-2736575974"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T00:00:00Z","timestamp":1777075200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T00:00:00Z","timestamp":1777075200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100001818","name":"Research to Prevent Blindness","doi-asserted-by":"publisher","award":["Unrestricted Grant to the Department of Ophthalmology"],"award-info":[{"award-number":["Unrestricted Grant to the Department of Ophthalmology"]}],"id":[{"id":"10.13039\/100001818","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Jpn J Ophthalmol"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To determine whether the effect of three muscle surgery for moderate to large angle exotropia can be better predicted by surgical dosage, or by pre-operative exotropia angle. We examined cases where identical surgical dose was performed for a wide range of preoperative angles 30 to 55\u0394.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study design<\/jats:title>\n                    <jats:p>Retrospective, interventional case study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients with exotropia 30\u201355\u0394 who underwent bilateral lateral rectus (BLR) muscle recession 7 mm and 4 mm unilateral medial rectus (UMR) muscle plication between 2014 and 2024 were included. Surgical effect was analyzed by linear regression against the amount of preoperative exotropia, as well as total millimeters of recession and plication. Success was defined as less than 10\u0394 exotropia or 5\u0394 esotropia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Thirty-four patients were included with 32 \u00b1 27 (standard deviation, SD) years mean age. Mean preoperative exotropia at distance was 42 \u00b1 6\u0394 (range 30\u201355\u0394), and 40 \u00b1 16\u0394 (range 6\u201370\u0394) at near. Surgical effect varied from 29\u0394 to 75\u0394, averaging 42 \u00b1 10\u0394, giving a mean dose response of 2 \u00b1 1\u0394\/mm. Linear regression showed that average surgical effect was equal to pre-operative deviation, accounting for 34\u201336% of variation in surgical effect. Success rate of this operation for all exotropia angles was 76% at 2 months mean followup.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Surgical effect for moderate to large angle exotropia does not strongly depend on surgical dose, so that successful outcomes measured 2\u00a0months post-operatively are obtained by performing a numerically identical procedure regardless of the pre-operative angle exceeding 30\u0394. Since outcome is attributable more to the biological response than to amount of surgery, pre-operative measurements require only\u00a0sufficient precision to confirm that the angle is moderate to large.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10384-026-01344-1","type":"journal-article","created":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T02:47:23Z","timestamp":1777085243000},"page":"759-764","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Challenge to the concept of surgical dose-response for moderate to large angle exotropia"],"prefix":"10.1007","volume":"70","author":[{"given":"Soh Youn","family":"Suh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingyu","family":"Meng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ami","family":"Tamhaney","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9662-5352","authenticated-orcid":false,"given":"Joseph L.","family":"Demer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,25]]},"reference":[{"key":"1344_CR1","unstructured":"Parks MM PJ. 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Y. Suh, None; Q. Meng, None; A. Tamhaney, None; J. L. Demer, None.","order":1,"name":"Ethics","label":"Conflicts of interest","group":{"name":"EthicsHeading","label":"Declarations"}}]}}