{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T20:21:46Z","timestamp":1787775706550,"version":"build-2784847793"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T00:00:00Z","timestamp":1745452800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To evaluate the techniques of augmented lateral rectus (LR) muscle recession with hang-back and Z-tenotomy in correcting large-angle exotropia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>This is a prospective, interventional, randomized clinical trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This institutional study included 62 patients with large-angle exotropia (40 \u0394 or greater). The patients were divided into two groups: Group A included 34 patients who underwent LR recession (7 mm) with hang-back, and Group B included 28 patients who underwent LR recession (7 mm) with Z-tenotomy. Ocular alignment, binocular vision, ocular motility, and satisfaction were evaluated as primary outcome measures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The angle ranged from \u221245 to \u2013140 \u0394 for Group A and from \u221240 to \u2013140 \u0394 for Group B. In Group A, 22 (64.7%) patients acquired orthophoria, while 12 (35.3%) remained exotropic at the 6-month visit. In Group B, 11 (39.3%) patients acquired orthophoria at the primary gaze position, while 17 (60.7%) remained exotropic after 6 months. None of the patients experienced abduction deficiency at the end of 6-month follow-up period. In Group A, the percentage of central fusion increased from 41.4% preoperatively to 68.9% at 6 months postoperatively, while stereopsis improved from 31.03% to 65.5%. In Group B, central fusion increased from 25% to 46.4% at 6 months postoperatively, while good stereopsis increased from 21.4% to 35.7%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Augmented LR recession with hang-back is an effective and safe procedure for the treatment of large-angle exotropia up to 90 PD, whereas Z- tenotomy is another augmentation technique for exodeviation angles less than 45 PD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ijo.ijo_1809_24","type":"journal-article","created":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T11:00:43Z","timestamp":1745492443000},"page":"758-763","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Evaluation of augmented lateral rectus recession by hang back and Z-tenotomy for correction of large-angle exotropia"],"prefix":"10.4103","volume":"73","author":[{"given":"Basma G","family":"Mohamed","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Faculty of Medicine, Tanta University, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed L","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Faculty of Medicine, Tanta University, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"El Sayed S","family":"Arafa","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Faculty of Medicine, Tanta University, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amr M","family":"Awara","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Faculty of Medicine, Tanta University, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heba M","family":"Shafik","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Faculty of Medicine, Tanta University, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,4,24]]},"reference":[{"key":"R1-20260422","doi-asserted-by":"crossref","first-page":"159","DOI":"10.3928\/0191-3913-19970501-06","article-title":"Psychosocial implications of strabismus surgery in adults","volume":"34","author":"Burke","year":"1997","journal-title":"J Pediatr Ophthalmol Strabismus"},{"key":"R2-20260422","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1067\/mpa.2002.122059","article-title":"Surgical results in large-angle exotropia","volume":"6","author":"Livir-Rallatos","year":"2002","journal-title":"J Am Assoc Pediatr Ophthalmol Strabismus"},{"key":"R3-20260422","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/S1091-8531(98)90004-0","article-title":"Large-angle exotropia corrected by intraoperative botulinum toxin A and monocular recession resection surgery","volume":"2","author":"Owens","year":"1998","journal-title":"J Am Assoc Pediatr Ophthalmol Strabismus"},{"key":"R4-20260422","doi-asserted-by":"crossref","first-page":"305","DOI":"10.3928\/01913913-20150609-02","article-title":"Three and four horizontal muscle surgery for large angle exotropia","volume":"52","author":"Chen","year":"2015","journal-title":"J Pediatr Ophthalmol Strabismus"},{"key":"R5-20260422","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/j.jaapos.2005.02.011","article-title":"Comparison of modified anchored \u201chang-back technique (HBT)\u201d with conventional HBT in bimedial rectus recession","volume":"9","author":"Chung","year":"2005","journal-title":"J Am Assoc Pediatr Ophthalmol Strabismus"},{"key":"R6-20260422","doi-asserted-by":"crossref","first-page":"31","DOI":"10.3928\/0191-3913-19890101-08","article-title":"Hang-back lateral rectus recessions for exotropia","volume":"26","author":"Cap\u00f3","year":"1989","journal-title":"J Pediatr Ophthalmol Strabismus"},{"key":"R7-20260422","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1016\/j.jaapos.2007.06.001","article-title":"A comparison of hang-back with conventional recession surgery for exotropia","volume":"11","author":"Orlin","year":"2007","journal-title":"J Am Assoc Pediatr Ophthalmol Strabismus"},{"key":"R8-20260422","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1016\/j.jaapos.2012.05.003","article-title":"The efficacy of superior oblique Z-tenotomy in the treatment of overdepression in adduction (superior oblique overaction)","volume":"16","author":"Brooks","year":"2012","journal-title":"J Am Assoc Pediatr Ophthalmol Strabismus"},{"key":"R9-20260422","first-page":"478","article-title":"The relationship between abduction deficit and reoperation among patients with infantile esotropia","volume":"11","author":"Rajavi","year":"2018","journal-title":"Int J Ophthalmol"},{"key":"R10-20260422","doi-asserted-by":"crossref","first-page":"2135","DOI":"10.2147\/OPTH.S253628","article-title":"Lateral rectus muscle tendon elongation by an auto graft from the resected medial rectus muscle as a monocular surgery for large-angle sensory exotropia","volume":"24","author":"Shafik","year":"2020","journal-title":"Clin Ophthalmol"},{"key":"R11-20260422","first-page":"73","article-title":"Exotropia","author":"Kushner","year":"2017","journal-title":"Find in Textbooks"},{"key":"R12-20260422","first-page":"1207","article-title":"Bilateral lateral rectus recession versus three-muscle surgery in management of exotropia","volume":"33","author":"Rajab","year":"2020","journal-title":"Menoufia Med J"},{"key":"R13-20260422","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1016\/0002-9394(65)93991-7","article-title":"The surgical management of exodeviations","volume":"59","author":"Burian","year":"1965","journal-title":"Am J Ophthalmol"},{"key":"R14-20260422","first-page":"97","article-title":"Results of large (8-9 mm) bilateral lateral rectus muscle recessions for exotropia","volume":"13","author":"Berland","year":"1998","journal-title":"Binocul Vis Strabismus Q"},{"key":"R15-20260422","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1177\/112067210101100102","article-title":"Large bilateral lateral rectus recession in large angle divergence excess exotropia","volume":"11","author":"Celebi","year":"2001","journal-title":"Eur J Ophthalmol"},{"key":"R16-20260422","first-page":"211","article-title":"Corneal astigmatic effects of conventional recession vs suspension recession (\u201c hang-back\u201d) strabismus surgery: A pilot study","volume":"21","author":"Betts","year":"2006","journal-title":"Binocul Vis Strabismus Q"},{"key":"R17-20260422","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1080\/09273972.2023.2239299","article-title":"A pilot randomized clinical trial comparing muscle transplant versus hang back recession in extra-large angle exotropia","volume":"31","author":"Pujari","year":"2023","journal-title":"Strabismus"},{"key":"R18-20260422","first-page":"97","article-title":"Mini-tenotomy procedure to correct diplopia associated with small-angle strabismus","volume":"107","author":"Wright","year":"2009","journal-title":"Trans Am Ophthalmol Soc"},{"key":"R19-20260422","first-page":"127","article-title":"Graded rectus muscle tenotomy","volume":"63","author":"Scott","year":"2005","journal-title":"Arch Chil Oftalmol"},{"key":"R20-20260422","first-page":"169","article-title":"Graded partial tenotomy of vertical rectus muscles for treatment of hypertropia","volume":"102","author":"Yim","year":"2004","journal-title":"Trans Am Ophthalmol Soc"},{"key":"R21-20260422","doi-asserted-by":"crossref","first-page":"162","DOI":"10.4103\/tmj.tmj_112_21","article-title":"Evaluation of the effect of combined Z-tenotomy and conventional recession of the lateral rectus for correction of comitant exotropia","volume":"49","author":"Ghalab","year":"2021","journal-title":"Tanta Med J"},{"key":"R22-20260422","doi-asserted-by":"crossref","first-page":"72","DOI":"10.4103\/dljo.dljo_84_23","article-title":"Surgical innovations in strabismus surgery\u2013A brief review","volume":"32","author":"Chaturvedi","year":"2022","journal-title":"Delhi J Ophthalmol"},{"key":"R23-20260422","doi-asserted-by":"crossref","first-page":"e237661","DOI":"10.1136\/bcr-2020-237661","article-title":"Foreign body episcleral suture granulomas mimicking nodular anterior scleritis","volume":"13","author":"Khoo","year":"2020","journal-title":"BMJ Case Rep CP"}],"container-title":["Indian Journal of Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/IJO.IJO_1809_24","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T19:39:42Z","timestamp":1787773182000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/IJO.IJO_1809_24"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,24]]},"references-count":23,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.4103\/ijo.ijo_1809_24","relation":{},"ISSN":["0301-4738","1998-3689"],"issn-type":[{"value":"0301-4738","type":"print"},{"value":"1998-3689","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,24]]},"assertion":[{"value":"2024-07-29","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-12-30","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}