To report mid-term success of surgery on virgin extraocular muscles( EOMs) or manipulated EOMs(which have been operated on in previous surgery) in the management of residual or consecutive esotropia(ET)and exotropia(XT)

of those who had a history of Bilateral medial rectus muscles(BMR) recession or resection, Bilateral lateral rectus muscles(BLR) recession or resection or "Recession and resection" of horizontal rectus muscles(R&R),more than 6 months ago,and had more than 15 prism diopters(PD) of residual or consecutive deviation.24 patients who meet inclusion criteria not exclusion ones randomized in "Manipulated " or "Virgin" group. Baseline examination included Visual acuity (VA) using Logarithm of minimum angle of resolution (log MAR) and Best corrected visual acuity(BCVA)(log MAR),Refraction(RFN) and baseline Cyclo-refraction(cyclo-RFN) (tomey-RC800), deviation(Cover-Uncover with Krimsky and Hirschberg test using prism bar).

A total of 24 patients distributed in one of the 2 groups. Mean Age in Virgin group was 28.83+-12.47 years(6-51yrs) And in Manipulated group was 18.25+-8.19 years(6-30yrs). Mean Pre op Deviation in Virgin group was 15-45 PD (25.42+-10.10) and 15-40 PD in manipulated group (28.33+-8.07).mean post operation(Post Op) deviation after6 month was0.9+-3.01 PD and 2.08+-4.98 PD in virgin and manipulated group respectively. After 6 months Just one patient in virgin group and 2 patients in manipulated group had 10 PD of deviation and all others had less than 8PD.

as result of two groups was insignificantly different, we prefer to suggest surgery on manipulated EOMs, cause carry less risk of Anterior segment ischemia and less conjunctiva manipulation that causes less dry eye complications.