Surgery of infantile esotropia: a critical evaluation of marginal myotomy of the medial recti as a primary and secondary procedure.

Seventeen cases of marginal myotomy were compared to 88 conventional procedures in treatment of infantile esotropia. Successful alignment (within 10 prism diopters of orthophoria) was less frequently attained in the marginal myotomy group than in the conventional group, both after one surgery (18% versus 40%, respectively) and finally (24% versus 65%, respectively). Motor and sensory findings were similar in each group, although fusion and stereopsis were less frequent with marginal myotomy. Even though nearly all patients receiving marginal myotomy were successfully aligned immediately following surgery, a gradual return of esotropia was noted in 12 of 17 patients. The significantly inferior ability of marginal myotomy to produce stable successful alignment in infantile esotropia should incontrovertibly lead to the abandonment of marginal myotomy in favor of the vastly superior recession and/or resection procedures. Twenty-one cases of marginal myotomies of the medial recti performed as secondary procedures were also analyzed. The group receiving myotomy with resection had much better results (4 of 5 successfully aligned, average exo-shift 27.6 P.D.) than the myotomy only group (2 of 17 successfully aligned, average exo-shift 6.6 P.D.). Three of 17 were actually made more esotropic by the myotomy procedure alone. It is concluded that isolated myotomy is an ineffective reoperative procedure, and that by combining myotomy with resection, a fair rate of successful alignment may be achieved.