Augmented medial rectus muscle recession versus medial rectus recession with posterior scleral fixation in partially accommodative esotropia: a randomized clinical trial

Abstract

To compare the postoperative alignment after medial rectus muscle posterior scleral fixation versus augmented recession in children with partially accommodative esotropia (PAET) without convergence excess. In this prospective study, 60 children with PAET without convergence excess were randomly assigned to either augmented medial rectus recession, based on the average of distance angle with correction and near angle without correction, or medial rectus recession, based on distance angle with correction, combined with posterior scleral fixation. The ductions, versions, angles of deviation, and difference between angles were analyzed before and 6months after surgery. Complete success was defined as orthotropia to within 8Δ of esophoria/tropia for both distance and near, with spectacle correction, at 6months. Patients who developed any exophoria/tropia with their original spectacles and needed reduction of their hyperopic correction to achieve successful outcome were defined as qualified successes. Of the 60 children, 25 in the augmented group and 28 in the posterior fixation group completed follow-up. The mean age at surgery was 4.90±2.34years. The complete success rate was 48% and 64% in the augmented and posterior fixation groups, respectively (P=0.15); the qualified success rate was 80% and 92.9%, respectively (P=0.17). Success rate was significantly higher (P=0.04) in the posterior fixation group (56%) than in the augmented group (18%) when the preoperative angle disparity was ≥20Δ. Medial rectus posterior scleral fixation can improve the success rate in PAET with large angle disparity.