Augmented-Dose Unilateral Recession-Resection Procedure in Acute Acquired Comitant Esotropia

Abstract

To compare the surgical amount of unilateral recession-resection (RR) procedure in patients with acute acquired comitant esotropia (AACE) versus common forms of esotropia (ET), and to provide dose-response reference for surgical planning in AACE. Retrospective study. Consecutive patients who underwent unilateral RR for AACE or ET correction from January 2018 to January 2022. Only patients achieved motor (residual deviation <5 prism diopters [Δ] in primary position) and sensory (elimination of diplopia in primary position and for reading) success with a minimum follow-up of 3 months were analyzed. Group difference in the amount of medial rectus recession (MRrec) and lateral rectus resection (LRres) was analyzed using multivariate regression models. Moreover, surgical dose-responses in the AACE group were analyzed using multivariable regression models. Regression models were performed with and without adjustment for clinical confounders. Piecewise analysis was used to detect segmented results. Group difference in surgical amount of MRrec and LRres, as well as dose-responses of unilateral RR in AACE patients with different-sized deviations. 54 AACE patients and 98 ET patients were included. Compared with the ET group, surgical amount performed was significantly larger in the AACE group to achieve a comparable effect of deviation correction. The adjusted group difference was 0.49 mm (95%CI=0.34-0.65; P<0.001) in MRrec and 1.68 mm (95%CI=1.25-2.11; P<0.001) in LRres in patients with horizontal deviation <40Δ; while only a mean difference of 1.22 mm (95%CI=0.76-1.6871; P<0.001) in LRres was found in those with deviation ≥40Δ. In the second part, dose-response analysis in AACE patients was performed with a determined cutoff deviation of 30Δ. In patients with deviation <30Δ, the adjusted dose-responses of MRrec and LRres were 5.11Δ/mm (95%CI=0.98-9.23; P=0.02) and 2.51Δ/mm (95%CI=0.57-4.45; P=0.02), respectively; while for those with deviation ≥30Δ, the adjusted dose-response of additional LRres was 5.48Δ/mm (95%CI=4.56-6.40; P<0.001) to correct the remaining deviation above 30Δ. These findings provide quantitative evidence that augmented-dosed unilateral RR should be performed in AACE for favorable surgical outcomes. The new surgical dose calculation proposed provide reference for surgical planning.