Surgical Outcomes of Medial Rectus Recession in Esotropia with Cerebral Palsy

Abstract

To determine the outcome of a reduced amount of medial rectus (MR) muscle recession in esotropes with cerebral palsy (CP) and to compare the surgical response with that of normal controls. Retrospective cohort study. Thirty esotropes with CP and 60 age-matched esotropes without CP who underwent a unilateral or bilateral MR muscle recession. The surgical amount of MR muscle recession was reduced by 1 mm per muscle in patients with CP. Success rates, surgical response, cumulative probabilities of success, and factors affecting surgical responses evaluated by generalized linear mixed models. In patients with CP, the initial success rate was higher (P = 0.037) and the rate of undercorrection was lower (P = 0.037) compared with patients without CP. At the final visit, success rates were not significantly different between both groups. However, the rate of overcorrection was higher (P = 0.003) compared with patients without CP. The rate of overcorrection per person-year during follow-up was 11% in patients with CP and 2% in patients without CP. Patients with CP showed a greater surgical response than did those without CP, at about 1.3 prism diopters per millimeter of MR muscle recession (P<0.001). Even with the reduced amount of recession, esotropes with CP showed a greater surgical response to MR muscle recession than did those without CP, and the incidence of late overcorrection was significantly higher compared with that of patients without CP.