To assess the postoperative surgical outcomes and the changes in deviation in patients treated by supermaximal recession and resection of rectus muscles to correct the large-angle esotropia with a mean follow-up of one years.

: In this prospective interventional case series, patients with primary constant esotropia with angles ≥65 D underwent strabismus surgery on two horizontal muscles. Surgery consisted of bilateral medial rectus muscles recession up to 8.5 mm in patients with bilateral deviation and up to 10.5 mm of lateral rectus resection combined with 8.5 mm medial rectus recession for unilateral exotropia on the nonfixing eye . Success was defined as horizontal deviation of ≤10 D.

A total of 48 patients (30 males and 18 females) were included. The mean age at surgery was 16.83±15.06 years. The mean preoperative esodeviations for bilateral and unilateral deviations were 69.5±6.5 and 80.7±10.3 respectively. At final follow-up examination, the mean postoperative (residual) deviations was 12.76±12.6 D. At the last follow-up 50 % were successfully aligned. 10.4 % of patients had persistent moderate limitation in the field of recessed or opposite field of resected muscles. no patient had diplopia on lateral gazes.None of the patients who had bilateral surgery complained of enophthalmos or narrowing of palpebral fissure.

In this patient cohort, supermaximal surgery on two muscles for large-angle esotropia successfully restored alignment in primary gaze in near 50 % of cases without inducing symptomatic adduction deficits.