Surgical Management of Residual or Recurrent Esotropia Following Maximal Bilateral Medial Rectus Recession

Abstract

To describe the effect of graded unilateral vs bilateral lateral rectus resection in the treatment of residual or recurrent esotropia after maximal medial rectus muscle recession. Methods: Retrospective case series of children with residual or recurrent esotropia. All children underwent initial eye muscle surgery for angles of 40 to 60 prism diopters (medial rectus recession of 5.5-6.5 mm; 11.0-11.5 mm from surgical limbus). If significant esotropia persisted or recurred, surgical results from graded lateral rectus resection were recorded. Results: Thirty-eight children were identified for the study. Unilateral lateral rectus resection ranging from 4 to 7 mm resulted in mean esotropic corrections of 10.5 to 14.9 prism diopters. Differences in surgical response per millimeter of unilateral lateral rectus resection were not significant. Bilateral lateral rectus resection of 5, 6, and 7 mm resulted in a mean correction of 19.75, 28.75, and 33.5 prism diopters, respectively. Conclusions: Graded lateral rectus resection can produce highly variable results on a case-to-case basis, but mean values trend in the expected direction. Residual deviations larger than 15 prism diopters need to be addressed with bilateral surgery.

Surgical success of lateral rectus resection for residual and recurrent esotropia

“…Our results are in agreement with Morrison et. al [11] who reported of no significant difference in surgical response per millimeter between first and second surgery. Therefore, they recommended that residual deviations larger than 15 PD need to be addressed with bilateral surgery [11].…”

“…al [11] who reported of no significant difference in surgical response per millimeter between first and second surgery. Therefore, they recommended that residual deviations larger than 15 PD need to be addressed with bilateral surgery [11]. Looking at our data from the first surgery, the amount of maximal medial rectus recession was 6.5-7.0 mm for each muscle, even when esotropia measured to be more than 50 PD.…”

“…Residual and recurrent esotropia following surgery are not uncommon [8,9]. Surgical methods for reoperation include uni-or bilateral lateral rectus resection [10][11][12][13] and medial rectus muscle re-recession [14]. Although broad published data regarding surgical success rate of primary surgery exists, data regarding consecutive surgery for residual or recurrent esotropia are sparse.…”

Outcomes of Bilateral Lateral Rectus Resection in Residual Esotropia following Bilateral Medial Rectus Recession

“…Limited data are available on the amount of correction gained with each millimeter of BLR resection. One reason for the wide range of reported successful outcomes for BLR resection, ranging from 52% to 87%, 5 6 7 8 is related to the diverse surgical dosage used during surgery.…”

“…5 6 There is a limited amount of data on the extent of correction gained with each millimeter of BLR resection. 7 8 Our experience has shown that resection based on surgical tables for unoperated muscles can cause overcorrection. Thus, we chose numbers that were 0.5 mm less than the proposed numbers in the standard table for primary BLR resection without a history of BMR recession given that the antagonist's muscles are weak here.…”