Outcomes of Medial Rectus Recession With Adjustable Suture in Acute Concomitant Esotropia of Adulthood

Abstract

Purpose: To review and analyze the surgical outcomes of bilateral medial rectus recession with adjustable suture in acute concomitant esotropia of adulthood (ACEA). Methods: The charts of all adults diagnosed as having ACEA between 2004 and 2017 were reviewed. Best corrected visual acuity, refractive error, ocular alignment measured in prism diopters (PD), and stereopsis were examined at presentation, 1 day postoperatively, and final follow-up visit (median: 10 months; range: 4 to 144 months). All patients underwent bilateral medial rectus recession using adjustable suture surgery and topical anesthesia. Statistical analysis was used to calculate surgical dose-responses and to study possible correlations with clinical parameters. Results: Fifteen patients diagnosed as having ACEA were included. The mean age was 39.2 ± 10.7 years, and the mean refractive errors in the right and left eyes were −3.97 ± 2.87 and −3.60 ± 2.74 diopters (D), respectively. Average esotropia deviations at near and distance were 22.7 ± 7.2 and 23.0 ± 7.5 PD. All patients improved with medial rectus recession (mean: 12.0 ± 2.2 mm) with a final mean deviation of 0.7 ± 1.8 PD. The mean dose-responses at 1 day postoperatively and final visit were 1.86 ± 0.58 and 1.83 ± 0.43 PD/mm, respectively. There was a significant positive correlation between surgical dose-responses at 1 day postoperatively and final visit and preoperative deviation ( R 2 = 0.55; P < .001; R 2 = 0.66; P < .001), whereas there were no significant correlations with age, sex, refractive error, BCVA, or stereopsis (all P > .05). Conclusions: Good postoperative and final outcomes are achieved with large medial rectus recessions in ACEA. A larger dose-response can be expected in large preoperative deviations, independent of other clinical and ocular parameters. [ J Pediatr Ophthalmol Strabismus . 2019;56(2):101–106.]

Magnetic resonance imaging of extraocular rectus muscles abnormalities in acute acquired concomitant esotropia

“…There are many treatment options for AACE [10,[33][34][35][36] . Previous research has suggested that strabismus surgery for AACE can successfully improve diplopia and restore good binocular function in patients who do not have underlying intracranial problems [37][38][39][40] . In AACE, surgical approaches include unilateral medial rectus recession and lateral rectus (R&R) resection, bilateral medial rectus recession, or bilateral LR resection.…”

Changes in the number and characteristics of patients with acute acquired concomitant esotropia over time: An 8-year retrospective study

“…BMR and unilateral R&R are the most common surgical procedures performed in patients with AACE. [3,5,6] The surgical outcomes of AACE are relatively favorable compared with those of other types of esotropia. [5] In this study, all patients who underwent surgery showed an improvement in diplopia.…”

“…[1] Prior published literature has provided details on classifications based on hypothetical mechanisms, the role of neuroimaging, and surgical outcomes. [2][3][4][5][6][7] AACE without intracranial lesions may not be a life-threatening condition. However, esotropia and diplopia cause discomfort and anxiety and can decrease the quality of life in patients with AACE.…”