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Irma Muminovic, Daniela Toffoli, Scott R. Lambert; Management of Restrictive Esotropia Following Pterygium Surgery. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2928. doi: https://doi.org/.
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Restrictive esotropia and diplopia can occur following removal of nasal pterygia and there is controversy regarding the management of this disorder. We performed a retrospective observational clinical study to learn more about the outcomes associated with the treatment of this condition.
A retrospective review of the management of 5 consecutive patients (mean age, 43 years; male, 4) who developed a restrictive esotropia following one or more nasal pterygia surgeries was performed. We recorded pre and postoperative motor alignment and abduction limitation, surgical management and final sensory status.
The mean preoperative deviation in primary gaze was 21.5 PD (range 4-50) and the mean preoperative limitation of abduction was -1.6 right eye and -2.75 left eye (Table 1) . The esotropia had been present for a mean of 9.6 months range (4 to 24 months). Forced ductions for abduction were positive for all patients at the time of surgery. Three patients underwent symblepharon excision, conjunctival-perimuscular fibrosis lysis, and conjunctival autograft or amniotic membrane transplantation without strabismus surgery whereas two patients underwent these procedures combined with bilateral medial rectus recessions using adjustable sutures (the use of adjustable sutures was complicated by the paucity of normal nasal conjunctiva). One patient was overcorrected and a second strabismus surgery was performed and one patient was undercorrected and subsequently underwent a botulinum toxin injection in one medial rectus muscle. At last follow-up, 4 of the 5 patients were orthotropic in primary position. Only one patient had a residual esotropia (8 PD) that was treated with a fresnel prism. Abduction was improved in all patients, but 3 patients continued to have diplopia in lateral gaze.
Even with forced duction testing it can be difficult to ascertain whether medial rectus recession should be coupled with symphepharon excision, fibrosis lysis and conjunctival autograft/amniotic membrane transplantation to treat restrictive esotropia following pterygia excision.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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