[Unilateral combined strabismus surgery to correct esotropia : Video article on recession of the medial rectus muscle and plication of the lateral rectus muscle].

OBJECTIVE OF SURGERY

The aim of strabismus surgery to correct esotropia is orthotropic alignment or microstrabismus to achieve best possible binocularity, a larger visual field, better appearance, and a frequently connected improved self-esteem. A widely used technique to correct esotropia is combined unilateral strabismus surgery with recession of the medial rectus muscle and plication of the lateral rectus muscle.

INDICATIONS

Indications are esotropia of various origins or decompensating esophoria over 15 prism diopters.

CONTRAINDICATIONS

Absolute contraindications are insufficient optical correction of hyperopia and sixth nerve palsy with unfinished spontaneous regeneration. A relative contraindication in children is untreated amblyopia.

SURGICAL TECHNIQUE

The technique consists of unilateral recession of the medial rectus muscle and tucking of the lateral rectus muscle. The surgical technique is demonstrated in detail in two videos of the operation, which are available online.

FOLLOW-UP: Antibiotic and lubricating eye drops are applied during the first week after surgery. In the early postoperative period, patients should be monitored for postoperative infection, conjunctival dehiscence, or corneal laceration. We review patients 4 months postoperatively for evaluation of the long-term result.

EVIDENCE

Recent randomized controlled studies have shown that unilateral medial rectus muscle recession and resection surgery is comparable to bilateral recession surgery with regards to postoperative results in esotropia. The effect of lateral rectus muscle tuck is comparable to muscle resection with less trauma and potential reversibility during the first days after surgery.