December 2002
Volume 43, Issue 13
ARVO Annual Meeting Abstract  |   December 2002
Bilateral Recess vs Recess-resect Surgery in Infantile Esotropia: a Prospective, Randomised, Multicenter Trial
Author Affiliations & Notes
  • HJ Simonsz
    Rotterdam Netherlands
  • JR Polling
    Rotterdam Netherlands
  • MJ C Eijkemans
    Rotterdam Netherlands
  • B Lieb
    Freiburg Germany
  • E Schulz
    Hamburg Germany
  • J Esser
    Essen Germany
  • GH Kolling
    Heidelberg Germany
  • B Lorenz
    Regensburg Germany
  • A ZubcovBR-RR Study Group
    Frankfurt Germany
  • Footnotes
    Commercial Relationships   H.J. Simonsz, None; J.R. Polling, None; M.J.C. Eijkemans, None; B. Lieb, None; E. Schulz, None; J. Esser, None; G.H. Kolling, None; B. Lorenz, None; A. Zubcov, None. Grant Identification: Netherlands Fund for Prevention of Blindness
Investigative Ophthalmology & Visual Science December 2002, Vol.43, 217. doi:
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      HJ Simonsz, JR Polling, MJ C Eijkemans, B Lieb, E Schulz, J Esser, GH Kolling, B Lorenz, A ZubcovBR-RR Study Group; Bilateral Recess vs Recess-resect Surgery in Infantile Esotropia: a Prospective, Randomised, Multicenter Trial . Invest. Ophthalmol. Vis. Sci. 2002;43(13):217.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract: : Purpose: Differences between bilateral recession (BR) and recession-resection (RR), the most common surgical procedures for horizontal strabismus, have never been assessed in a randomised study. Methods: 9 German and 5 Dutch clinics recruited 3- to 8-year-old children with infantile esotropia. Exclusion criteria were: previous surgery, binocular vision (including Bagolini), near angle / far angle ≷ 3/2, far angle ≷ 24° or < 10°, acuity 1 line acuity difference, large hypermetropia or myopia, substantial up- or downshoot, V- or A-pattern or manifest hypertropia ≷ 4°. The day before surgery, the latent angle at distance fixation in degrees was divided by 1.6 to obtain millimeters of recession and/or resection. Then the child was randomised to receive either BR or RR surgery the following day. Uniform guidelines on orthoptic and operative techniques were enforced by regular visits and photographs taken during surgery. Primary outcome measures were angle with alternating cover at distance fixation and remaining convergence excess, 3 months postoperatively. Results: 120 children will have been operated at conclusion of the study on December 31st 2001. Preliminary analysis without breaking the code (n=85) showed no difference between BR and RR. Average effect was only 1.4° per mm, s.d. 0.4. A smaller preoperative angle was correlated with less effect. Conclusion: This prospective, randomised, controlled study failed to confirm purported differences between BR and RR in effect on angle with alternating cover at distance fixation. Cases with a preoperative angle <15° had less average effect. The average effect was approx. one s.d. below current guidelines for horizontal strabismus surgery, reflecting the tendency to avoid overcorrection. 

Keywords: 588 strabismus • 591 strabismus: treatment • 357 clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials 

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