Bilateral Medial Rectus Muscle Recession Results in Children with Developmental Delay Compared to Normally Developed Children

Abstract

Introduction: Children with developmental delay have a high rate of esotropia. Nevertheless, strabismus surgery for neurologically impaired children is less predictable; treating them by the standard surgical schedules may attain high rates of overcorrection. We compared bimedial rectus muscle recession (BMR) results for esotropia in children with developmental delay to the results in normal children. Methods: A retrospective analysis of all children that underwent BMR surgery for esotropia during a 10-year period was undertaken. Surgical results of children with developmental delay were compared to those of normal children. Results: In the developmentally delayed group the mean angle of esotropia prior to surgery was 53± 12 PD; the mean amount of medial rectus recession was 5.4± 0.56 mm, 0.84 mm less than the standard amount of recession. At the last follow-up visit only 56% achieved surgical success (within 10 PD of orthophoria). Among failures, 86% were undercorrected, and only one patient developed consecutive exotropia. In the developmentally intact group the mean angle of esotropia prior to surgery was 37.4± 8 PD, the mean amount of medial rectus recession was 5.2± 0.65 mm, and 94% achieved surgical success. Conclusion: A higher rate of surgical failure was found in developmentally delayed children who received a smaller recession of the medial rectus muscles when compared to the developmentally normal children receiving the standard amount of recession. The main reason for surgical failure in the developmentally delayed group, during follow-up of 2 years, was undercorrection. Decreasing the surgical table in children with developmental delay may lead to undercorrection; therefore, we need to delineate the ideal amount of surgery in this group.