{
  "abstract": "Purpose\n\nWe investigated the outcomes of simultaneous three- or four-horizontal muscle surgery for very large-angle exotropia (> 60 prism diopters [Δ]).Subjects and methods\n\nThis retrospective study included 24 patients (16 with convergence insufficiency-type and 8 with basic-type exotropia). The deviation angle was measured using the alternate prism and cover test, and stereopsis was evaluated. Patients were classified into three groups (F: ≤ 60 arcsec (\"), C: 60\"<, and N: nil stereoacuity). A successful motor outcome was defined as ≤ 10Δ of orthotropia. Pre- and postoperative results were compared.Results\n\nMean preoperative exodeviation at distance and near were 75.2 ± 13.0Δ and 89.2 ± 18.0Δ, respectively. Mean age at surgery was 47.8 ± 16.5 years, and mean follow-up period was 3.6 ± 4.2 years. Thirteen and 11 patients underwent four- and three-muscle surgeries, respectively. The mean distant and near deviations at 3 months postoperatively and at the final visit were 5.3 ± 10.4Δ and 8.4 ± 9.5Δ, 5.5 ± 8.6Δ and 9.4 ± 9.0Δ, respectively. No differences were found in the near and distant deviations between the two time points. The motor success rates at both time points were 63%. Stereopsis at the final visit improved significantly from F:4%, C:38%, and N:58% before surgery to F:38%, C:50% and N:13% at the final visit (P = 0.002, McNemar-Bowker test).Conclusions\n\nThree- or four-horizontal muscle surgeries for very large-angle exotropia are effective in achieving favorable motor outcomes and stereopsis.",
  "abstract_shown": true,
  "affiliations": [
    "Yagasaki Eye Clinic, Ichinomiya, Aichi, Japan.",
    "Chukyo Eye Clinic, Nagoya, Aichi, Japan."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 3,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Ayaka Yagasaki",
      "orcid": "0000-0002-3564-9825"
    },
    {
      "affs": [
        0
      ],
      "name": "Teiji Yagasaki",
      "orcid": "0000-0002-0038-2884"
    },
    {
      "affs": [
        1
      ],
      "name": "Kazuo Ichikawa",
      "orcid": "0009-0001-6165-154X"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/193rvz3d5gzg3.bib",
  "cited_by": 0,
  "doi": "10.2147/opth.s643692",
  "fulltext_url": "https://europepmc.org/articles/PMC13678120",
  "id": "193rvz3d5gzg3",
  "issns": [
    "1177-5467",
    "1177-5483"
  ],
  "landing_url": "https://europepmc.org/article/MED/42898777",
  "language": "eng",
  "licence": "CC-BY-NC",
  "licence_label": "CC BY-NC",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2734|Ophthalmology and Eye Disorders"
    ]
  ],
  "openalex": "W7221674364",
  "pdf_url": "https://europepmc.org/articles/PMC13678120?pdf=render",
  "pmcid": "PMC13678120",
  "pmid": "42898777",
  "published": "2026-10-13",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/193rvz3d5gzg3.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:33Z",
      "native_id": "MED:42898777",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42898777"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2734|Ophthalmology and Eye Disorders",
      "subfield": "general"
    }
  ],
  "title": "Outcomes of Simultaneous Three- or Four-Horizontal Muscle Surgery for Very Large-Angle Convergence Insufficiency-Type and Basic-Type Exotropia.",
  "title_text": "Outcomes of Simultaneous Three- or Four-Horizontal Muscle Surgery for Very Large-Angle Convergence Insufficiency-Type and Basic-Type Exotropia.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:19:33Z",
  "url": "https://research.draconitic.com/paper/193rvz3d5gzg3",
  "venue": "Clinical ophthalmology (Auckland, N.Z.)",
  "versions": []
}