Bimedial rectus plication in Residual exotropia

Introduction: Residual exotropia refers to a constant outward deviation of eye noted after strabismus surgery for exotropia once postoperative healing is complete (≥6-8 weeks). Management of residual exodeviation necessitates careful evaluation and meticulous surgical planning to achieve optimal outcomes. Methods: A 28-year-old male presented with a 40 prism-diopter residual left exotropia associated with poor convergence. He had a history of childhood strabismus surgery in the left eye; however, the operative records were not available. Preoperative anterior segment optical coherence tomography (AS-OCT) was used to aid surgical planning. Bimedial rectus plication was performed. Results: An early desirable postoperative outcome of 2-4 prism-diopters of esophoria was achieved. At three-month follow-up, ocular alignment remained stable with no diplopia, and convergence showed significant improvement. Discussion: Although resection has traditionally been the preferred extraocular muscle strengthening procedure, it necessitates irreversible removal of muscle tendon. Medial rectus plication offers a vessel-sparing, reversible alternative that can enhance adduction and convergence while preserving ocular perfusion.