'Restraining the over-achiever' in incomitant strabismus: Scott's resect-recess procedure re-visited

Abstract

Purpose : In 1994 Scott reported an alternative to Faden operation for management of incomitant strabismus, resecting and recessing a single yoke muscle in the fellow eye to match the duction deficit of the paretic eye. He advocated large resections equivalent to the Faden procedure, resulting in post-equatorial insertion to each muscle, citing potential adjustment and greater effectiveness of lateral rectus weakening as advantages over Faden procedure.
We adjusted his treatment recommendations, reducing the amount of surgery with the aim of 1: correcting the primary deviation while 2: leaving the muscle insertion posterior to the maximal recommended recessions preformed in strabismus practice, so as to induce a matching duction deficit. We report our result using this alternative technique.

Methods : We reviewed the charts of all adult patients who underwent the modified Scott procedure under our care from 2008 to 2018. Patients were included if they had a full orthopric evaluation before and after and at least 10 weeks after the procedure.

Results : Nineteen patients (19 eyes) underwent this procedure for incomitant strabismus. The ethiology was paretic (13) or restrictive (6 patients). Eleven had no previous strabismus surgery. Eight had isolated combined resect-recess surgery and 11 others has simultaneous rectus/ oblique muscle surgery. Rectus muscle operations were as follows: Medial: 9, Inferior: 6, Lateral: 3 and Superior: 1. An adjustable suture was used in every case but only in 5 of the 19 patients required adjustment. Average follow up was 1 year (range: 2.4m-7.7y). This surgery resulted in reducing in the degree of incomitance in all patients (average 69.7% - 5 to 45 PD). The technique was particularly helpful for inferior rectus surgery (85.8% reduction). 74% became orthophoric in primary position. Both paretic and restrictive etiologies had good results (63%, 83%). Three of 19patients 16% were overcorrected. Two required prisms to control a small comitant deviation.

Conclusions : Modified resect-recess surgery was an effective treatment for incomitant strabismus. The greatest reduction in incomitance was achieved on the inferior and lateral rectus.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.