Wright central plication of lateral rectus versus standard medial rectus recession in adult divergence insufficiency esotropia.

PURPOSE

Wright central plication is a minimally invasive tightening procedure described for the first time by Wright and colleagues in 2012. We compare outcomes of lateral rectus central plication (LRCP) to medial rectus recession (MRR) in the treatment of adult divergence insufficiency esotropia (ADIE).

METHODS

A retrospective chart review of 30 consecutive patients with ADIE, who underwent either LRCP or MRR between 2010 and 2015 was performed.

INCLUSION CRITERIA

age ≥45 years, LRCP or MRR surgery fixed suture technique, esotropia (ET) at least 10 greater at distance than at near, subjective diplopia at distance, fusion at near fixation, follow-up of at least 6 months. Primary outcome was postoperative single binocular vision. Secondary outcome was postoperative deviation of <5.

RESULTS

A total of 28 patients (15 females) met inclusion criteria: 15 had LRCP and 13 MRR. Primary outcome of no diplopia was not significantly different between LRCP and MRR group having a success rate of 93.3% versus 92.3%, respectively (P ≤ 0.01). Secondary outcome of a deviation of ≤5 at distance was better in the LRCP group than the MRR group (15/15 vs 11/13 [P ≥ 0.01]). One patient in LRCP group had an early overcorrection corrected by in-office suture lysis.

CONCLUSIONS

Both procedures had excellent primary outcomes eliminating diplopia in over 90% of cases. The LRCP group had statistically better postoperative alignment of <5. The Wright LRCP has the advantage of being minimally invasive, semi-reversible, vessel sparing, and can be done with topical anesthesia.