Adult divergence insufficiency esotropia: a comparison of lateral rectus resection, medial rectus recession, and miniplication of lateral rectus

Abstract

Purpose The aim of this study was to compare the outcomes and efficacy of three surgical procedures for correction of adult divergence insufficiency esotropia: lateral rectus resection (LRR), medial rectus recession (MRR), and Wright lateral rectus miniplication (LRMP). Patients and methods A retrospective study was conducted on 22 patients with adult divergence insufficiency esotropia who were operated between 2012 and 2016; eight of them underwent LRR, six underwent MRR, and eight underwent LRMP. Their age ranged from 45 to 68 years. Esotropia was at least 10Δ greater at distance than at near. All patients did not have significant esotropia at near [0–6 prism diopter (PD)] with fusion at near; all of them complained of diplopia for far with no underlying neurological diseases. The mean follow-up period was 24 (12–40) months. Achieving single vision at far and postoperative deviation of up to 5 PD was considered a successful result. Results Age at presentation was 45–68 years, with mean age of 56.8±7.7 years. All the cases underwent bilateral surgeries. In group LRR, the preoperative angle of deviation at far was 20.5±5.8 prism diopter(PD) and for near was 2.9±2.4 PD. In group MRR, the preoperative angle of deviation at far was 21.7±6.1 PD and for near was 3.5±2.8 PD. In group LRMP, the preoperative angle of deviation at far was 21.4±8.5 PD and for near was 3.1±2.7 PD. Postoperative, no cases of diplopia were reported along the follow-up period in groups MRR and LRMP, whereas one case of the eight cases of group LRR showed diplopia. The postoperative angles for far in LRR, MRR, and LRMP groups were 2.38±2.1, 2.5±2.3, and 2.25±1.8 PD, respectively. Conclusion The three procedures had excellent outcomes in eliminating diplopia and postoperative alignment, but LRMP has the advantage to be vessel sparing, less invasive, reversible, and being able to be done with topical anesthesia.