Bilateral Medial Rectus Recession Research Articles

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.
 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.
 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).
 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).

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

This 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 risk factors associated with recurrence. A total of 104 patients diagnosed with AACE between October 2020 and January 2021 were included and voluntarily chose to undergo augmented surgery or BTXA injection. The follow-up assessments ended in November 2022. Multivariable linear regression analysis was used to identify potential factors that influence the dose-response of bilateral medial rectus recession (MRrec). Kaplan-Meier survival analyses and Cox proportional hazards models were performed to evaluate rate and risk factors for AACE relapse. A total of 31 AACE patients chose augmented-dosed esotropia surgery, and 73 chose BTXA treatment. During the 2-year follow-up, the surgical group achieved more stable postoperative results with no recurrence of diplopia, while only 68.68% (95% CI 55.31% to 78.79%) patients achieved orthophoria in the BTXA group. For patients undergoing BTXA treatment, hours of near work per day were demonstrated to be a significant risk factor for AACE relapse (HR 1.29, 95% CI 1.00 to 1.67). The dose-response of augmented-dosed bilateral MRrec was positively correlated with preoperative deviation angle (R2=0.833; β=0.043, 95% CI 0.031 to 0.055; p<0.001). Our findings provided quantitative evidence that augmented-dosed surgery would achieve more stable and favourable surgical outcomes for AACE patients compared with BTXA injection. However, BTXA treatment is still proposed for patients with small deviation angles due to its advantages of reduced trauma, operational simplicity, low cost and quick recovery.

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).

Assessment of the surgical outcomes of esotropia in pediatric subjects with high accommodative convergence/accommodation ratio

Background: Treating subjects with a high AC/A ratio and with esotropia is a challenging and complex procedure, often associated with increased near deviation which may lead to various outcomes following the surgery. Aims: The present study was conducted to assess outcomes following surgery in children with esotropia who were surgically treated with primary bilateral medial rectus (BMR) recessions. The study also compared preoperative and postoperative measurements in subjects with a high AC/A ratio to a normal AC/A ratio to assess surgical outcomes. Materials and Methods: 122 subjects were divided into 2 groups based on AC/A ratio into high AC/A ratio and normal AC/A ratio The subjects with high AC/A were treated with bifocal management if they had near persistent ET of ≥10Δ in full cycloplegic correction and not if they had far ET of ≥10Δ. Target angle at the time of the surgery was assessed with stereopsis presence via positive butterfly/fly, and near and distance deviations ≤10Δ within orthophoria. These success outcomes were compared in subjects with normal AC/A ratio and AC/A ratio groups. The collected data were subjected to statistical evaluation.

Large bilateral medial rectus recession versus three-to-four horizontal muscle surgery for large-angle esodeviations.

The best surgical approach to correcting large angle esodeviations is still debated. Options for correcting large esodeviations include recessing both medial rectus (BMR) muscles more than 5.5 mm or performing surgery on three or four horizontal rectus muscles. There remains no consensus on which surgery has better survival outcomes. In this research, we are interested in determining the survival rates and long-term outcomes of both surgeries locally in the Philippines. A total of 74 medical records were retrospectively reviewed. The mean age at onset of deviation was 2 ± 2.9 years old, and the mean age at surgery was 14 ± 12.5 years, with a mean of 12 ± 12.1 years from onset to surgery. The mean follow-up period was 9.9 months (range 6-24) . The mean preoperative deviation at near was 59.3 ± 13.6 PD (range: 35-95) while at distance was 58.5 ± 13.6 PD (range 10-95). The most common type of esotropia (ET) was infantile ET (45%), followed by basic ET. Majority of the esodeviations did not have associated vertical strabismus (67.6%, n = 50). Overall success rate was 48.1% for BMR recessions and 54.5% for 3-4 muscles surgery. Survival analysis revealed the decreasing trends of survival but plateauing of outcomes after 6 months. We reported the outcomes for both surgeries. Neither had shown superiority over the other. After a mean follow up of 9.9 months, the overall success was relatively good: 50% were successful, 39.2% overall recurrence and 13.8% overcorrections. Survival plots showed a plateauing of results after 6 months.

Y-splitting medial rectus muscle and recession in treatment for convergence excess esotropia.

To evaluate the surgical outcome of medial rectus (MR) recession with Y-splitting procedure in treatment of esotropia with convergence excess. Medical records were retrospectively reviewed for those patients who underwent surgical treatment for their convergence excess esotropia (CEET) between January 2018 and December 2020. Refractive error was examined by the equipment of the VS100 (Welch Allyn). The surgical approach was bilateral MR recession with Y-splitting. The amount of recession was calculated according to the deviation angle at distance. Ocular movement and ocular alignment at distance and near were evaluated pre- and post-operatively. Binocular sensory status was evaluated by the Bagolini striated glasses at near and distance, and by stereoacuity assessment at near using the Titmus test. Six patients with CEET were included in this study. Four of them were hyperopia and two of them were myopia. A mean of eso-deviation angle at distance had been changed from 27.3±13.02 prism diopters (PD) preoperatively to 1.83±1.60 PD postoperatively (P<0.05), while a mean of eso-deviation angle at near had been changed from 50.00±20.74 PD preoperatively to 6.83±0.98 PD postoperatively (P<0.05). Patients had obtained binocular vision postoperatively. The surgical approach of Y-splitting MR and recession is effective in treatment of CEET.

Conventional surgery versus botulinum toxin injections for partially accommodative esotropia

To compare the effect of botulinum toxin injection (BTX) to bilateral medial rectus recession (BMR) in partially accommodative esotropia (PAET). The medical records of children 1-14 years of age treated for PAET with BMR or BTX between 2010 and 2020 at a single institution were reviewed retrospectively. PAET was defined as residual esotropia of at least 14Δ after 6 weeks of continuous wear of full cycloplegic refraction (> +2.5 D). Success was defined as esotropia of 0Δ-10Δ after a single surgery or ≥1 BTX injections. Of 224 patients, 121 received BTX and 103 underwent BMR. BMR showed a higher success rate than BTX (70.9% vs 53.7% [P = 0.006]). BMR was more successful in males, in patients >5 years of age, and when spherical equivalent was ≤ +5.00 D (79.2%, 74.3%, and 67.5%, resp. [P < 0.05]). Mean follow-up was shorter in the BMR group than in the BTX group (16.7 ± 14.7 vs 31.4 ± 29.5 months [P = 0.0001]). Mean duration of surgery was significantly shorter in the BTX group (5.2 ± 4.3 vs 70.5 ± 31.4 min [P = 0.0001]). Postoperative inferior oblique overaction was more common in the BTX group (7.4%; P = 0.02 [Fisher exact test]), and persistent ptosis was only seen in the BTX group (0.8%); consecutive exotropia was only seen in the BMR group (2%). In our study cohort, BMR had a higher success rate than BTX. Conventional surgery allowed for shorter follow-up and fewer complications than BTX in the treatment of PAET.

Outcomes of Bilateral Lateral Rectus Resection in Residual Esotropia following Bilateral Medial Rectus Recession.

Purpose:To evaluate the success rate, dose-response ratio, and predictive factors of success in patients with residual esotropia (≥25 prism diopter [pd]) following bilateral medial rectus (BMR) recession who underwent bilateral lateral rectus (BLR) resection.Methods:In a retrospective study, medical records were reviewed for 47 patients with equal or more than 25 pd residual esotropia following 6 mm BMR recession. Sex, age at second surgery, the interval between first and second surgery in months, visual acuity, refraction, presence of amblyopia, presence of dissociated vertical deviation or inferior oblique overaction/superior oblique overaction, preoperative and postoperative angle of deviation, amount of BLR resection, and months of follow-up were evaluated. Surgical success was defined as postoperative deviation within 8 pd of orthophoria.Results:The mean age of patients at reoperation was 48.59 ± 21.46 months. The mean near and far residual esotropia before BLR resection was 34.57 ± 11.02 and 33.83 ± 10.99 pd, respectively, reduced to 8.12 ± 1.43 pd in near and 6.32 ± 2.1 pd in far postoperatively. The mean BLR resection dosage was 5.53 ± 1.22 mm and each millimeter of BLR resection (1 mm for each eye) corrected an average of 7.95 pd of deviation in near and 7.40 pd in far. The success rate was 74.5%. After analysis using multivariate logistic regression, there were no factors associated with success.Conclusions:Bilateral rectus resection in patients with a previous BMR recession has acceptable outcomes. The recommended surgical table can be used as a guide by strabismus surgeons in patients with residual esotropia.

Esotropia management: outcomes and prognostic factors

AbstractPurposeWe aimed to study the epidemiological and the clinical characteristics of esotropia, to report the results of the medico‐surgical management, and to analyze the various factors that may influence the postoperative prognosis.MethodsMedical records of 130 patients who underwent esotropia surgery between 2000 and 2015 were retrospectively reviewed. Ophthalmological examination and complete sensorimotor assessment were performed for each patient. All surgeries were made by the same surgeon. We operated simultaneously on the horizontal and vertical elements. Total optical correction and amblyopia treatment were started before surgery. We studied the influence of certain prognostic factors on motor outcome, such as strabismus type, age at the onset, delay of surgical management, degree of amblyopia, preoperative deviation angle, and a vertical syndrome presence.ResultsThe mean age was 8 ± 4.20 years. Our patients had infantile esotropia in 52.3% of cases. The age of strabismus onset was 2 years ± 2.2 years on average. Our patients had amblyopia in 70.7% of cases. A bilateral medial rectus muscle recession was performed in half of our patients with an associated Faden operation in 46.2%. We obtained a motor success rate of 85.38% after a single operation and a global success rate of 91.54%. A stable fusion and stereoscopic vision were present in only 4.6% of cases preoperatively and 6.92% of cases postoperatively. Surgical dosage and postoperative day 1 angle were significantly associated with motor outcome (p = 0.009 and p &lt; 0.001).ConclusionsEsotropia represents 83.3% of all strabismus. The infantile esotropia group had the worst motor and sensory status. Concerning the surgical protocol, the vertical syndrome is often operated on the same time as the horizontal deviation. Bilateral medial rectus muscle recession is the most practiced surgery. Unilateral surgery of recession/plication is indicated for deviations between 30 and 45 diopters and in the case of amblyopia. Bilateral surgery on 3 horizontal muscles is indicated in deviations of more than 45 diopters. Faden operation is indicated in angle variability of more than 15 diopters. The success rate for convergent strabismus varies between 48 to 90%.

Comparative study between medial rectus slanting versus medial rectus Faden with or without recession for management of esotropia with distance/near disparity: a retrospective study

AimsThis study aimed to compare the efficacy of medial rectus slanting recession and the bilateral medial rectus Faden with or without recession in the management of any type of convergence excess esotropia with low or high accommodative convergence/accommodation ratio.Patients and methodsA total of 38 patients with convergence excess esotropia were divided into group A, which underwent bilateral medial rectus recession according to the average angle of near and distance, and group B, which underwent bilateral medial rectus Faden technique with or without recession. All patients who met the inclusion criteria of the study had complete ophthalmic examination done including deviation angle measurement for near (NCC) and for far (DCC). Patients were followed up immediately, 6 months, and 1 year after the operation.ResultsAt all follow-up times, postoperative NCC and DCC measurements revealed high frequency of ortho and residual esotropia of 10 PD or less in both groups with no significant differences (P > 0.05). There was a significant decrease in the mean ranks of each of NCC and DCC at the postoperative follow-up times (immediately, 6 months, and 1 year) in comparison with the preoperative measures (P < 0.05). Alternatively, comparison of NCC and DCC measured at immediate, 6 months, and 1-year postoperative follow-up times revealed no significant differences (P > 0.05).ConclusionThe slanted recession and Faden with or without recession on bilateral medial rectus muscles were effective in reducing the near-distance disparity esotropia regardless of the level of accommodative convergence/accommodation ratio, with stability of results throughout a follow-up period of 1 year.

Impact of Adding Augmented Superior Rectus Transpositions to Medial Rectus Muscle Recessions When Treating Esotropic Moebius Syndrome

To describe outcomes after treatment of Moebius syndrome (MBS) esotropia by adjustable bilateral medial rectus recession (BMR) with and without augmented superior rectus transposition (SRT). Retrospective case series. Patients meeting 2014 diagnostic criteria for MBS and treated at Boston Children's Hospital between 2003 and 2019 were identified via billing records and chart review. Visual acuity, sensorimotor evaluations, strabismus procedures, and other clinical features were recorded. Surgical outcomes for patients treated with strabismus surgery (excluding those with prior surgery elsewhere) were evaluated. The primary outcome measure was postoperative alignment comparing treatment by adjustable BMR vs adjustable BMR+SRT. A total of 20 patients had MBS, and 12 of these (60%) were male. Fifteen patients (75%) had primary position esotropia, and all had bilateral abduction deficit. Eight of 20 patients met inclusion criteria for primary strabismus surgery outcome. Five had undergone adjustable BMR ranging from 4.5 to 6.5 mm. Three had undergone adjustable BMR+SRT, all with 4-mm medial rectus muscle recessions. Mean preoperative esotropia before treatment by BMR was 39.5 PD (± 15 PD) with mean postoperative esotropia 9 PD (± 7.9 PD) at 6 months. Mean preoperative esotropia before treatment by BMR+SRT was 70.8 PD (± 5.9 PD) with mean postoperative esotropia 2.5 PD (± 3.5 PD) at 6 months. Significantly greater reduction in esotropia resulted from BMR+SRT than from BMR (P=.036). BMR proved sufficient to treat esotropia <50 PD and BMR+SRT for greater esotropia in patients with MBS-associated abduction limitation.