Augmented re-recession using muscle transplantation and saccadic velocity change in supra-large-angle recurrent-residual exotropia

We report two cases of large-angle recurrent-residual exotropia despite previous lateral rectus (LR) recessions bilaterally. The ultimate treatment involved augmented LR re-recessions using muscle transplantation combined with medial rectus (MR) resection. Due to extensive conjunctival fibrosis, amniotic membrane grafting (AMG) was done additionally in the first case. The patients achieved optimal surgical outcomes with minimal limitation of abduction on follow-up. There was no change in palpebral aperture width and minimal scarring. No recurrence was observed at 1-year follow-up. Marked improvement in saccades was noted post-operatively on saccadic analysis.