Bilateral Medial Rectus Recession Research Articles

Acute Acquired Comitant Esotropia

Acute acquired comitant esotropia (AACE) is an infrequent presentation of esotropia, characterized by sudden onset eye misalignment and diplopia. The purpose of this article is to review four cases of children diagnosed with AACE. We present 4 cases (children 610 years) of AACE. All of them suddenly developed diplopia and esotropia, with largeangle. After complete ophthalmological and neurological examinations in three cases out of four, strabismus surgery was conducted. In one case heterogenous neoplasm was detected and sent to an oncologist and neurosurgeon for evaluation and morphological verification. Bilateral medial rectus recession in two cases and unilateral recession of the medial rectus and resection of the lateral rectus in one case were performed. After strabismus surgery fully recovered binocular vision and was no longer noticeable diplopia. Neurological examinations and neuroimaging should be performed to exclude any potential intracranial disease. Surgery should be taken into consideration 6 months after the onset of the esotropia, if the deviation is stable. Strabismus surgery of AACE has good motor and sensory results and can successfully restore good binocular function The excessive use of smartphones may be associated with developing and increasing AACE.

Microcephaly with or without chorioretinopathy, lymphedema, or mental retardation (MCLMR)- the new lacunae: a case report

BackgroundMicrocephaly with or without chorioretinopathy, lymphedema, or mental retardation is a rare autosomal dominant disease caused by mutations in KIF11 which disrupt EG5 protein function, impacting the development and maintenance of retinal and lymphatic structures due to its expression in the retinal photoreceptor cilia. The primary ocular finding in MCLMR is chorioretinopathy. Additional features can include microphthalmia, angle-closure glaucoma, persistent hyperplastic primary vitreous, cataract, pseudo-coloboma, persistent hyaloid artery, and myopic or hypermetropic astigmatism. The appearance of the chorioretinal lesions as white to pinkish, round, non-elevated atrophic areas devoid of blood vessels resembles the lacunae in Aicardy syndrome. Due to the lack of systematic description of the lesions and significant phenotypical variability, there is an impending need for a detailed report of each case.Case presentationA child with microcephaly detected in the third trimester of gestation began her following in the ophthalmology department due to a non-visually significant cataract. Shortly after, she developed nystagmus and large-angle alternating esotropia with cross-fixation. Her fundus initially showed a pallid optic disc and pigmentary changes, developing thereafter retinal lacunae and a retinal fold. Her differential diagnosis accompanied the dynamic changes in her fundus, which included congenital infections, Leber´s Congenital Amaurosis and Aicardy syndrome. At 19 months old, genetic testing identified a heterozygous mutation (c.1159 C > T, p.Arg387*) in the KIF11 gene. The patient underwent bilateral medial rectus muscle recession surgery at 2 years old for persistent esotropia, with significant improvement. Refraction revealed a hyperopic astigmatism in both eyes (+ 0.25 -2.50 × 180 OD and + 0.75 -2.00 × 170 OS). She continues to require right eye patching for 2 hours daily.ConclusionsThis case report expands the phenotypic spectrum of MCLMR by demonstrating a unique combination of retinal features which sheds new light on differential diagnosis from Aicardy syndrome. Our findings emphasize the significant phenotypic variability associated with MCLMR, particularly regarding ocular involvement. This underscores the importance of detailed clinical evaluation and comprehensive reporting of cases to improve our understanding of the disease spectrum and genotype-phenotype correlations.

Bilateral medial rectus recession with or without posterior fixation in large-angle infantile esotropia: a randomized controlled trial.

To compare the results of bilateral medial rectus recession (BMRc) versus bilateral medial rectus recession with Faden operation (BMRF) in the treatment of large-angle infantile esotropia. A double blinded, parallel, randomized controlled trial. Patients with large-angle infantile esotropia (≥ 60 prism diopters, [PD]) aged between 3 and 15 years old were included and assigned to either the BMRc or BMRF group. Mean difference and mean reduction of angle deviation between the two groups were compared at 1 week, 1, 3, and 6 months by using generalized estimating equations analysis. Surgical success rates, defined as an esodeviation ≤ 10 PD at near fixation, were evaluated at 6 months postoperatively. Complications from the surgical procedures were observed. Of 40 enrolled patients, the mean (SD) age of the patients in the BMRc group was 3.4 (1.9), and in the BMRF group, 5.2 (3.8) years old. The overall mean differences of angle reduction between both groups were not significant (-6 PD, 95%CI -14 to 2, P = .12). The surgical success rate at 6 months in the BMRF group (72%) was not different compared to BMRc group (84%, P = .45). Overall consecutive exotropia was 5%, not different between groups (P > .99). There was no difference of complications between the two groups (P = .51). BMRF and BMRc approaches show no difference in treatment of large-angle infantile esotropia. Nevertheless, a long-term assessment for consecutive exotropia should be considered for both surgical procedures.

Efficacy of augmented-dosed surgery versus botulinum toxin A injection for acute acquired concomitant esotropia: a 2-year follow-up

Background/aimsThis study aims to evaluate the clinical efficacy of botulinum toxin type A (BTXA) injection and augmented-dosed surgery in the treatment of acute acquired concomitant esotropia (AACE), and explore potential...

Characteristics and Surgical Outcomes of Comitant Esotropia in an Adult Population Between 18 and 60 Years Old

PurposeTo describe the clinical characteristics and surgical outcomes of adults with comitant non-accommodative esotropia. DesignRetrospective case series MethodsRetrospective review of medical records of patients 18 to 60 years old with comitant esotropia who underwent strabismus surgery at a tertiary eye care center between 2014 and 2023. The etiology of esotropia was categorized into three groups based on the disparity between near-distance angles of deviation: 1. basic esotropia (ETBA); 2. esotropia divergence insufficiency pattern (ETDI); or 3. esotropia convergence excess pattern (ETCE). The main outcome measures were strabismus characteristics and motor and sensory surgical outcomes. Surgical motor success was defined as a deviation that measured ≤ 10 prism diopters (PD). ResultsOf the 219 that met the inclusion criteria, most patients were female (140, 64%) and had a mean age of 36.7 ± 12.3 years (range 18-60 years). The majority were myopic (157, 72%) and reported diplopia (176/219, 80.3%). The ETCE group had the largest mean deviations at both distance (45.5 ± 11.5 PD) and near (64 ± 12.3 PD) while the ETBA group had the largest ranges at distance (31 ± 13.5 PD, range 3-90) and near (30 ± 15 PD, range 2- 85). Bilateral medial rectus recession (BMR) and unilateral recess-resect (R&R) procedures were performed with equal frequency (both 48%). Motor and sensory success were achieved more often with R&R than BMR, although only motor success was statistically significant (87.8% vs. 73.2%, p=0.0375 and 93.3% vs. 85.5%, p=0. 15 respectively). At the last encounter, 88.1% (119/135) of patients with pre-operative diplopia achieved single binocular vision. ConclusionsRegardless of the pattern of esotropia, strabismus surgery in adults with comitant non-accommodative esotropia resulted in good motor and sensory outcomes.

Clinical characteristics and treatment outcomes of myopic children and adolescents with acute acquired comitant esotropia

ABSTRACT Clinical relevance Acute acquired comitant esotropia (AACE) is becoming increasingly common in young children. Understanding clinical characteristics and treatment outcomes can inform future practice. Background To evaluate clinical characteristics of myopic children and adolescents with AACE, and the outcomes of varying treatments. Methods A retrospective review of medical records was conducted to identify patients diagnosed with AACE and diplopia between 2016 and 2020. The duration of smartphone use, angle of deviation, refractive error, stereopsis, and treatment options were analysed. The motor outcomes were evaluated at the earliest 6-month postoperative visit (6–30 months), and orthotropia or esodeviation ≤10 prism dioptres (PD) was defined as success. Successful sensory outcomes were defined as the elimination of diplopia in primary gaze or the presence of stereoacuity. Results Twelve patients diagnosed with AACE were identified. Ages were between 9 and 19 years (15.6 ± 3.3 years). All patients showed convergent and comitant esotropia ranging from 12 to 40 PD at distance fixation that was nearly equivalent for distance and near fixation. The mean age at the initial visit was 15.6 ± 3.3 years. Post-treatment esodeviations were significantly lower at both distance and near compared to pretreatment (p < 0.001, for both). Eight patients required surgery and were treated with bilateral medial rectus muscle recession, two patients were treated with botulinum toxin, and two patients were followed with prismatic glasses. Nine of 10 patients (%90) treated with either surgery or botulinum toxin had successful motor and sensory outcomes. Conclusions Surgery is the most efficient treatment option; botulinum toxin and prismatic glasses could be useful treatment options in patients who refuse to have surgery or for whom the amount of deviation is small and variable.

Long-term Ocular Alignment and Sensory Outcomes After Medial Rectus Recession for High AC/A Ratio Esotropia.

To report long-term ocular alignment and sensory outcomes after medial rectus recession for high accommodative convergence/accommodation (AC/A) ratio esotropia. The medical records of consecutive patients who had undergone unilateral or bilateral medial rectus recession for high AC/A ratio esotropia and were observed postoperatively for a minimum of 5 years were reviewed retrospectively. A total of 34 patients were included. Twenty-three patients (68%) used bifocals preoperatively. The mean age at surgery was 11.5 ± 4.4 years (range: 2.5 to 19.0 years). The mean postoperative follow-up was 7.5 ± 2.3 years (range: 5.0 to 15.25 years). Overall, 21 patients (62%) had surgical success at their last follow-up visit. Age at surgery, preoperative angle of distance and near deviation, distance-near disparity, and preoperative bifocal wear did not predict motor outcome after surgery. Preoperative presence of peripheral binocular single vision was a significant favorable factor for surgical success. At the last follow-up visit, 21% of patients had a recurrence of high AC/A ratio esotropia and 9% each had consecutive exotropia (intermittent [3%] and constant [6%]) and basic esotropia. Peripheral binocular single vision was achieved in 64% of patients and stereopsis in 28%. Bifocal segment was eliminated postoperatively in 70% of patients. Nearly two-thirds of patients with high AC/A ratio esotropia achieved a successful long-term motor outcome and peripheral binocular single vision, and nearly one-fourth achieved stereopsis. Recurrence of high AC/A ratio esotropia occurred in some patients, and consecutive exotropia and basic esotropia in a few. Bifocal segment was eliminated postoperatively in 70% of patients. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XX-XX.].

Long-Term Effects of Botulinum Toxin A Versus Incisional Surgery for Management of Partially Accommodative Esotropia in Children: Comparison of Three Approaches

Purpose: To compare the effect of bilateral medial rectus injection of botulinum toxin A (BTX-A), bilateral medial rectus muscle recession surgery (BMR rc), or unilateral medial rectus muscle recession combined with lateral rectus muscle resection surgery (R&R), in the management of partially accommodative esotropia (PAET) in children.Design: Retrospective comparative clinical study.Methods: The study cohort included 98 patients diagnosed with PAET who had BTX-A injection or incisional surgery between December 2014 and January 2023. The main outcome measures included motor and sensory results as well as complications. Follow-up was at least 12 months for all patients.Results: There were 28 patients in the BTX-A group, 45 in the R&R group, and 25 in the BMR rc group. The motor success rates at distance and near fixation respectively were 50% (14/28) and 54% (15/28) in the BTX-A group, which were lower than that of the R&R group [78% (35/45), 84% (38/45)] and the BMR rc group [72% (18/25), 84% (21/25)] (P = 0.042 for near and P=0.006 for distance). For patients with onset age <2.5 years old, there was no statistical difference amongst the three surgical approaches (P=0.656). For patients with onset age ≥2.5 years, the motor success rate of the R&R group [81% (26/32)] and the BMR rc group [88% (14/16)] was higher than that in the BTX-A group [38% (5/13); P=0.004]. There was no statistical difference in sensory outcomes for patients regardless of onset age or treatment methods (P>0.05 for all). During follow-up, 4% (2/45) of patients in the R&R group and 20% (5/25) in the BMR rc group developed consecutive exotropia; no patient in the BTX-A group was overcorrected (P=0.017).Conclusions: Bilateral medial rectus muscle injection with BTX-A in patients with PAET is a safe, accessible, and low-cost alternative. Although motor success rates were higher, overall, in patients treated with incisional surgery, for patients with earlier age of onset (≤ 2.5 years old), BTX-A injection may be preferred to incisional surgery. In older children treated with unilateral recession-resection surgery, fewer developed consecutive exotropia.

Risks and Complications Discussed in Consent for Strabismus Surgery

ABSTRACT This study is a qualitative analysis of the consent process for strabismus surgery, using recordings of physicians doing a mock consent for bilateral medial rectus recession. There is considerable variation in the risks of surgery and odds of complications that are cited by pediatric ophthalmologists during the consent process. We propose a reference table with complication rates for use during the consent process.

Factors Predictive of Surgical Success in Medial Rectus Resection/Advancement for Consecutive Exotropia

Background and Objective: Consecutive exotropia after unilateral or bilateral medial rectus recession is a common clinical problem. One surgical intervention to address the misalignment involves isolating and reattaching healthy muscle to the globe. The purpose of this study was determining factors indicative of surgical success in medial rectus resection and advancement with non-adjustable sutures for consecutive exotropia.&#x0D; Methods: Through retrospective chart review, 118 patients were identified to have consecutive exotropia using billing codes from June 2016 to October 2020 at Indiana University Health. 60 of these patients who maintained adequate follow-up either underwent the above intervention (n = 49) or underwent resection only (n = 11). Exclusion criteria included lack of medial rectus procedure or poor postoperative documentation. Patient demographics and data were gathered, including preoperative and intraoperative measurements, final postoperative deviation, and whether additional surgeries were necessary. Chi-squared and two-sample t-tests were performed to analyze the effect of each parameter on surgical success, defined as distance deviation ≤ 10 prism diopters of esotropia or exotropia at final postoperative visit.&#x0D; Results: Smaller total intraoperative adjustment–resection plus advancement–was significantly associated with surgical success (p = 0.044). Additionally, smaller preoperative deviations were significantly associated with patients who underwent unilateral surgery (p = 0.0093 near and 0.0021 distance).&#x0D; Conclusion: Patients with smaller preoperative deviations tended to have better outcomes, and those patients tended to have unilateral surgery. It is unclear whether a smaller deviation might have led surgeons to select unilateral medial rectus surgery or if the smaller deviation itself is a predictor of success. Relatively limited time of follow-up is a limitation in this study, as there is well-documented postoperative drift of increasing exotropia over time. A larger cohort or randomized controlled trial may provide additional insight that could increase the percentage of successful outcomes with a single surgery.

Unusual outcome of strabismus surgery in a case of Apert syndrome: A case report

Abstract Apert syndrome (AS) is a form of acrocephalosyndactyly, which is characterized by craniosynostosis, midfacial hypoplasia, and symmetrical syndactyly of the hands and feet. A 3-year-old female with craniosynostosis, high-arched palate, syndactyly, strabismus, and diagnosed as a case of Apert syndrome was brought to the outpatient department. Strabismus evaluation revealed 35 prism diopters of left convergent squint. Magnetic resonance imaging of the brain and orbit revealed hypoplastic extraocular muscles. A plan to carry out a bilateral medial rectus recession was made. However, intraoperatively, normal-sized muscles were found and the plan was modified to carry out only a left eye medial rectus recession of 5.5 mm. The patient was orthophoric postoperatively, indicating the unusual postoperative outcome in such a case. This report aimed to underline the challenges of managing a case of strabismus and the variable postoperative outcomes encountered in a case of Apert syndrome.

Treatment of Infantile Esotropia - Comparison Between Botulinum Toxin A and Bilateral Medial Rectus Recession.

The objective of the study is to evaluate the examination findings, treatment methods, and follow-up results of children diagnosed with infantile esotropia (IE) and to compare botulinum toxin A (BTA) and bilateral medial rectus (MR) recession surgery. We retrospectively reviewed the medical records of patients who were diagnosed with IE. The age of the patient and the angle of deviation were taken into account to determine the treatment. Patients who underwent bilateral MR recession surgery and BTA injection were analyzed and the BTA and surgical groups were compared. Successful correction was defined as orthotropia and a deviation of up to 10 prism diopters (PD) after one surgical procedure or 1-3 botulinum injections. Two hundred and forty-six patients with esotropia were included in the study. Twelve were followed up with refractive correction only. BTA injection was administered to 110 patients, while 124 patients underwent bilateral MR recession. The age of the patients ranged from three to 39 months. Patients were followed for at least 6 months, with a mean follow-up of 24.3 months in the BTA group and 21.7 months in the surgical group (p=0.23). The mean pre-treatment angle deviation was 38.9 PD in the BTA group and 40.1 PD in the surgical group (p=0.62). The success rate for patients with more than 30 PD of deviation was 72% in the surgical group compared to 36% in the BTA group (p<0.001). No statistically significant difference in success rate was observed in patients with deviations <30 PD (surgery 62%, BTA 55%, p=0.26). Surgical treatment of IE was more successful than BTA injection in patients with large angle deviations (>30 PD). BTA injection can be considered as an alternative to surgery in cases of small to moderate angle deviations (<30 PD).

Long-term results of strabismus surgery for treatment of esotropia in patients with Möbius syndrome

To evaluate the surgical results of Möbius syndrome esotropia following bilateral medial rectus recession with and without bilateral Hummelsheim procedure. The medical records of patients with Möbius syndrome operated on by a single surgeon from 1993 to 2022 were studied retrospectively. For each patient, age, sex, and ocular deviation before and after surgery were retrieved. Success was defined as a horizontal deviation of up to 15Δ and vertical deviation of <10Δ. Eleven patients were included. Average patient age at the time of surgery was 4 years. Eight patients with esodeviation up to 70Δ underwent bilateral medial rectus recession; 3 patients with esotropia >70Δ underwent recession plus bilateral Hummelsheim procedure. The mean esodeviation before surgery was 52.5Δ in the first group and 86.6Δ in the second group. The mean horizontal deviation at early follow-up was esotropia of 7.4Δ in the first group and of 15Δ in the second group. The early success rate was 87% in the first group and 67% in the second group. Long-term follow-up revealed exoshift in 43% of the patients in the first group and all 3 patients in the second group. In our small patient cohort of patients with Möbius syndrome, bilateral medial rectus recession corrected esodeviations of up to 70Δ. In more severe cases (>70Δ), adding bilateral Hummelsheim procedure was beneficial.

Effect of bimedial recession on near-distance disparity in esotropia.

Esotropia may be associated with a difference in the deviation at near and distance fixation termed near-distance disparity (NDD). Convention suggests patients with NDD may benefit more from bilateral medial rectus recessions (BMR) as opposed to a unilateral recession/resection (RR). The aim of this study is to establish the effect of BMR for the treatment of esotropia on both the near and distance deviation and NDD. Retrospective patient records search from 2011 to 2021. comitant esotropia, first surgery, equal and normal vision with free alternation. incomitant, neurological or restrictive strabismus, previous surgery, clinically significant amblyopia. 49 patients met the inclusion criteria. 19 patients were female; the average age was 17 years. Following surgery, the average near deviation reduced from 39PD base out (BO) to 11PD BO. The average distance deviation reduced from 33PD to 9PD. Average preoperative NDD was 12 PD. NDD resolved in 15 out of 18 patients with NDD (83%). The average PD gain per mm of recession was 2.7 for near and 2.2 for distance. BMR is an effective surgical treatment for esotropia and has a greater effect on near deviation than distance. It is also an effective and simple technique for lesser degrees of NDD. BMR has several advantages over RR: no tissue loss, readily reversible, the scars are easier to hide and it avoids potential motility limitations due to leash effects following resection.

Efficacy of botulinum toxin injection versus bilateral medial rectus recession for comitant esotropia: a meta-analysis.

To compare the effectiveness of botulinum toxin injection (BTX) and bilateral medial rectus recession (BMR) in the treatment of comitant esotropia. An exhaustive search of the literature from Pubmed, EMBASE, Web of Science, and Cochrane Library databases was carried out until April 2022. No language restrictions were applied. The literature was rigorously screened against eligibility criteria. Odds ratios (ORs) and 95% confidence interval (CI) were calculated. A total of 9 articles with 1100 participants were included in this meta-analysis. Three studies compared the effects of BTX to BMR on infantile esotropia, five studies compared the effects of BTX to BMR on acute acquired comitant esotropia, and one study compared the therapeutic effects between BTX and BMR for partially accommodative esotropia. Our pooled results showed that BMR achieved higher overall success rate compared with BTX (OR, 0.49; 95%CI, 0.37-0.64; P < 0.001) and patients subjected to the BTX procedure had higher overall rate of undercorrection (OR, 2.27; 95%CI,1.71-3.02; P < 0.001). No statistical difference in the overall overcorrection rate was observed between the two groups (OR = 0.42, 95% CI: 0.17 ~ 1.03, P = 0.06). Further analysis found that BMR was more effective for infantile esotropia compared to botulinum toxin injections (OR, 0.40; 95%CI, 0.27-0.57; P < 0.001). Nevertheless, the same effect was observed for BMR and BTX in the treatment of acute acquired comitant esotropia (OR, 0.97; 95%CI, 0.50-1.87; P = 0.93). The present meta-analysis indicated that the BMR procedure achieved a higher success rate and a lower undercorrection rate in patients with comitant esotropia. However, BTX demonstrated similar treatment effects to BMR surgery in the treatment of acute acquired comitant esotropia.

Evaluation and Management of Divergence Insufficiency-Type Esotropia

ABSTRACT Divergence insufficiency-type ET is a common cause of distance diplopia in elderly adults. A recent prospective multicenter data collection study has provided additional guidance on management. Either base-out prism glasses or strabismus surgery were found to have high success rates, based on patient report of diplopia, and health-related quality-of-life domain scores. It was concluded that either prism or surgery were reasonable initial treatment strategies. Although allocation bias precluded formal comparison of prism versus surgery (evident in baseline differences between groups), there were hints that surgery may yield superior outcomes. For surgery, the most common approach was bilateral medial rectus recession, which was highly successful when assessed 10 weeks and 12 months postoperatively. It was unclear whether adjustable sutures were helpful, but in the vast majority of adjustable cases, additional recession at the time of adjustment was performed, suggesting that larger than standard surgical doses are needed.

Comparison of Unilateral and Bilateral Surgical Approaches for the Treatment of Age-Related Divergence Insufficiency Esotropia

ABSTRACT Purpose Age-related divergence insufficiency-esotropia (ARDIE) is characterized by greater esodeviation at distance than near. This study aims to compare the outcomes of unilateral and bilateral surgical approaches. Patients and Methods Sixty-two cases treated at the Kellogg Eye Center, the University of Michigan, from 1995 to 2018 were retrospectively reviewed. One surgeon used unilateral procedures including unilateral medial rectus recession (n = 24, group 1) or unilateral recession-resection (n = 18, group 2) with an adjustable suture. Another surgeon used bilateral medial rectus recession with fixed sutures (n = 20, group 3). Results For patients with distance esodeviation <15∆, postoperative distance deviations in both group 1 and group 3 were not statistically different (p = .352). For patients with esodeviations 15–20∆, postoperative distance deviations in all 3 groups were also not statistically different (p = .142). Similarly, patients with deviations >20∆ did not show significantly different postoperative distance alignment (p = .082) between group 2 and 3. Overall, group 2 had the highest overall success rate (90%) (mean at distance = 1.17∆ exodeviation, at near = 2.33∆ exodeviation). Conclusion Both unilateral medial rectus recession ± lateral rectus resection and bilateral medial rectus recession surgical approaches produced similar favorable outcomes in ARDIE.

Comparison of Dose Increments of Botulinum Toxin A with Surgery as Primary Treatment for Infantile Esotropia and Partially Accommodative Esotropia.

PurposeTo compare the effect of increment dose of botulinum toxin (BTX) injection in correlation to the angle of deviation to bilateral medial rectus recession (BMR) in infantile esotropia and partially accommodative esotropia (PAET).MethodsThis was a retrospective study that included pediatric patients ≤16 years old with infantile esotropia and PAET at Dhahran Eye Specialist Hospital (DESH) from 2014 till 2021 treated with increment dose of BTX or BMR. A successful outcome is defined as ocular alignment within 10 PD of deviation after 1–3 BTX injections or one surgery with a minimum follow-up of 6 months.ResultsOf 177 patients, 101 patients received BTX treatment for either infantile esotropia (n = 37) or PAET (n = 64) and 76 patients underwent BMR for either infantile ET (n = 25) or PAET (n = 51). BTX showed a higher success rate than BMR {65.3% vs 55.3% (p = 0.174)}. In patients with infantile esotropia, the success rate was comparable between BTX group and BMR group {40.5% vs 52% (p = 0.440)}. However, the success rate was statistically significantly higher in BTX group in compare to BMR group {79.7% vs 56.9% (p = 0.014)}. Consecutive exotropia was 0% in BTX group and 9.2% in BMR group (p = 0.002).ConclusionThe increment dose of BTX injection is comparable to surgery in patients with infantile esotropia but superior to the routine surgery in patients with PAET. BTX has the advantage of a shorter procedure duration, lower costs, less exposure to general anesthesia and being minimally invasive intervention.

Effect of bimedial recession on near distance disparity in esotropia

Bilateral medial rectus recession (BMR) and unilateral recession-resection (RR) are well-established surgical techniques for esotropia. There is no consensus on which is preferable although convention suggests a greater effect of BMR on near deviation. We present a series of patients who underwent BMR for esotropia and the effect on the near and distance angles.

Impact of adding augmented superior rectus transpositions to medial rectus muscle recessions when treating esotropic möbius syndrome

Effective management of the esotropia characterizing Möbius syndrome (MBS) remains a clinical challenge. The purpose of this study was to compare the pre- and postoperative characteristics of patients with MBS esotropia treated by adjustable bilateral medial rectus recessions (BMR) versus those treated by adjustable BMR plus augmented superior rectus transpositions (BMR+SRT).