The management of congenital esotropia has long been a topic of controversy, not only concerning when to operate but also as to the best surgical approach. Success rates ranging from 40 to 80% have been described with a variety ofsurgical techniques. ' This paper shows that bimedial rectus recessions in excess of the traditional 5 mm have a high success rate in the management of the congenital esotrope with a deviation of 50 prism dioptres or greater.
Materials and methodsThe records of 218 patients with congenital esotropia who underwent surgery at the Wills Eye Hospital between 1979 and 1983 were reviewed. Forty-five patients met the criteria for inclusion in this study, which were as follows: (1) esotropia documented by one of the authors before 6 months of age, (2) preoperative deviation of 50 prism dioptres or greater, (3) alternation of fixation, (4) correction of hyperopic refractive errors greater than 2 dioptres with spectacles, (5) age at operation less than 2 years, (6) no overt evidence of central nervous system abnormalities or organic eye disease, and (7) followup of six weeks or more. Deviations were evaluated by the Hirschberg or Krimsky methods, or by the prism and cover test at distance when possible. Cycloplegic refraction with 1% cyclopentolate and in some cases 1% atropine was performed in all cases.
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