Bilateral true muscle transplantation for correction of very large angle exotropia

A 59-year old man with very large exotropia and bilateral limitation of adduction, underwent bilateral true muscle transplantation, involving the sutured transfer of resected segment of medial rectus (MR) onto the distal end of lateral rectus (LR), prior to recession of the thus elongated LR muscle. Following this he was left with mild residual exotropia and improved adduction, which has remained stable for 6 months following surgery.