Bilateral Medial Rectus Muscle Recession: Results in Children With Developmental Delay Compared With Normally Developed Children

Abstract

We sought to compare bimedial rectus muscle recession (BMR) results for esotropia in children with developmental delay with the results in normal children. A retrospective analysis of all the children that underwent standard BMR surgery for esotropia during a 10 year period was undertaken. The surgical results of children with developmental delay were compared with those of normal children. In the developmentally delayed group, the mean angle of esotropia before 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, and at the last follow-up visit only 56% achieved surgical success (within 10 PD of orthophoria). Among the failures, 86% were undercorrected, only one patient developed consecutive exotropia after surgery. In the developmentally intact group, the mean angle of esotropia before surgery was 37.4+/-8 PD, the mean amount of medial rectus recession was 5.2+/-0.65 mm, and 94% achieved surgical success. Among surgical failures, we observed only a single case of overcorrection. A higher rate of surgical failure was found in developmentally delayed children who received a smaller recession amount of the medial rectus muscles when compared with the developmentally normal children who received a standard amount of recession. The main reason for surgical failure in the developmentally delayed group, in a follow-up period of 2 years, was undercorrection of the angle of esotropia. It seems that decreasing the surgical table by a certain amount in children with developmental delay may lead to undercorrection. Therefore, we need to delineate the ideal amount of surgery in this unique group of individuals.