To evaluate the efficacy of slanted recession of the lateral rectus (LR) muscle for exodeviation with larger deviation angle at near than far fixation.

A retrospective chart review was conducted of 31 patients. Seventeen patients underwent slanted LR recession, the upper fiber of the LR was recessed according to the distance deviation angle and the lower fiber was recessed according to the near deviation. Fourteen patients underwent classic recession. To evaluate the effect of slant LR recession, postoperative ocular alignment between them was checked at 1 week, 1 month, 3 months and 6 months after operation.

At the postoperative 6 months, bilateral slanted LR recession reduced the mean exodeviation at near from 33.82 PD to 7.29 PD, and same amount recession group reduced 33.67 PD to 11.13 PD. The far deviation change was from 25.59 PD to 2.59 PD, 23.67 PD to 4.00 PD in each group. The change of near-distance difference was from 10.29 PD to 4.71 PD in slanted recession group, and 9.67 PD to 7.93 PD in same amount recession group, showed that slanted recession group reduced angle more significantly ( p = 0.002). Success rate was 35% in bilateral slanted LR recession group, 7% in classic recession group, showed that slanted recession group had significantly high success rate ( p < 0.05).

Bilateral slanted LR recession effectively reduces near and distance exodeviation angle, and reduces near-distance incomitance more superior to classic bilateral LR recession technique.