Abstract
Background: Beside combined recess-resect procedures, bilateral medial rectus recession and bimedial posterior fixation sutures and also a combination of both are common in surgery for infantile esotropia. We compared bilateral medial rectus recession and bimedial posterior fixation sutures in childhood esotropia with variable squint angles. Patients and methods: Prospective, randomised single center trial of patients with childhood esotropia with variable squint angles and a maximum of ≤ 20° und ≥ 25° treated with bilateral medial rectus recession or bimedial posterior fixation sutures. We evaluated preoperative, 2 days, 3 months and 1 year postoperative data. Primary outcome measures were success rates for squint angles in alternating prism cover test, success was defined as squint angles within 5°, simultaneous perception in Bagolini-Test and stereopsis in Titmus-Test one year after surgery. Secondary outcome measures were rate of over- and undercorrections and rate of reoperations. Results: 88 patients were included in the study. 42 patients received bimedial posterior fixation sutures (group 1), 46 patients received bimedial rectus-recession (group 2). No statistically significant differences between the two groups were found in the baseline data including age of surgery, sex, refraction and squint angle at distance and near. Postoperative squint angle at distance (mean ± SD) one year after surgery was +7,4 ± 5,8° in group 1 and 1,3 ± 4,6° in group 2, p < 0,001. Postoperative squint angle at near (mean ± SD) one year after surgery was +7,4 ± 5,8° in group 1 and 1,3 ± 4,6° in group 2, p < 0,001. Success rates for squint angles at distance one year after surgery: group 1 32,3 %, group 2 73,5 %, p = 0,001. Success rates for squint angles at near one year after surgery: group 1 16,1 %, group 2 58,8 %, p = 0,001. Simultaneous perception at distance (Bagolini-Test) one year after surgery: group 1 32,3 %, group 2 55,9 %, p = 0,081. Simultaneous perception at near (Bagolini-Test) one year after surgery: group 1 38,7 %, group 2 61,8 %, p = 0,084. Stereoacuity (Titmus-Test) one year after surgery: group 1 3,2% housefly pos., group 2 8,8 % housefly pos., 5,9 % 200´´, 2,9 % 50´´, p = 0,326. Conclusion: Bimedial rectus recession is statistically significant more effective for correction of squint angles than bimedial posterior fixation sutures in childhood esotropia with variable squint angles and a maximum deviation of 20-25°.
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