Medial rectus surgery for convergence excess esotropia with an accommodative component: a comparison of augmented recession, slanted recession, and recession with posterior fixation.

UNLABELLED

Richard G. Scobee was an internationally renowned strabismologist whose life was short yet very productive. The first section of this paper describes his life and contributions to strabismology and orthoptics. The second section of this paper reports the results of our strabismological study.

INTRODUCTION AND PURPOSE

Many different surgical procedures exist for the treatment of children or adults with convergence excess esotropia. We report on our results of augmented recession, slanted recession, and recession with posterior fixation of the medial rectus muscle in such situations. We also report on the incidence of induced vertical deviations.

METHODS

Using a retrospective chart review of 800 patients, we excluded patients with confounding strabismus conditions and pharmacological treatments leaving 131 patients included in the study. Slanted reinsertion of medial rectus (twenty-seven patients); posterior fixation with recession of medial rectus (twenty-two patients); augmented medial rectus recession (fifty-eight patients); nonaugmented recession of medial rectus (seventy-three patients). The distance near disparity postoperatively was evaluated using a life table analysis in which all patients were grouped according to the length of time postoperatively. Induced vertical deviation was evaluated at least 6 months postoperatively.

RESULTS

At all time periods postoperatively, the patients with slanted recessions showed the greatest reduction in distance near disparity and that reduction was the most stable over time. At 12- 14 months postoperatively, the range in reduction measured 7.9- 11(Δ) among all three procedures. At 15- 18 months postoperatively, the range in reduction measured 16.9- 19.3(Δ) diopters among the three procedures. At greater than 6 months postoperatively, the slanted and augmented recession groups showed up to 1(Δ) of right hypertropia and the posterior fixation and nonaugmented groups showed up to 0.6(Δ) of left hypertropia.

CONCLUSIONS

All three medial rectus procedures used in our retrospective study (slanted recession, augmented recession, recession with posterior fixation) reduced the distance near disparity. The greatest and most stable reduction at all time periods postoperatively occurred with the slanted recession. The induced vertical deviation is small in all procedures and is acceptable at 1(Δ) or less. The augmented and slanted recessions are easier to perform than the posterior fixation with recession. We recommend that the slanted reinsertion of the medial rectus recession be considered as a viable option in the surgical correction of esotropia with a distance near disparity.