Abstract
Purpose :
To compare the surgical outcomes of medial rectus (MR) recession and lateral rectus (LR) resection in patients with acquired comitant distance esotropia (ET).
Methods :
In this retrospective comparative study involved 22 patients who underwent MR recession (MR-Rec) or LR resection (LR-res) for diplopia caused by the acquired comitant distance ET. Acquired comitant distance ET was defined when comitant ET was more than eight prism diopters (PD) larger angle at distance than near and diplopia at distance with or without diplopia at near. Comprehensive ophthalmic examinations included cycloplegic refraction, assessment of the best corrected visual acuity (BCVA), extraocular muscle movement, ocular deviation using prism alternate cover test, and presence of diplopia at distance and near. Surgical success was defined as the final deviation of < 10 PD and diplopia-free at distance and near. The mean dose-effect ratio(PD/mm) was defined as the corrected angle of deviation/sum of the amount of recession of LR or resection of MR.
Results :
Among 22 patients, 13 underwent MR recession, and nine underwent LR resection. There was a significant difference in the ET angle at distance between groups (MR-Rec vs. LR-Res, 29.0 PD vs. 21.4 PD, p=0.03), however there was no significant difference the angle at near (MR-Rec vs LR-Res, 17.0 PD vs 10.6 PD, p=0.07) and distance-near disparity (MR-Rec vs LR-Res, 11.9 PD vs 10.7 PD, p=0.69) between groups.
The surgical success rate was higher in LR-Res group than in MR-Res group at the final follow-up (MR-Rec vs LR-Res=69% vs 100%, p=0.11). Three patients had under-correction, and one patient had over-correction in the MR-Rec group. The mean dose-effect ratio at one year after surgery was 2.15 ± 0.93 for distance and 1.69 ± 1.06 for near in MR-Rec group, and 1.91 ± 0.51 for distance and 1.13 ± 0.52 for near in LR Res group.
Conclusions :
Our results showed that LR resection had a better surgical outcome compared to the MR recession in the patients with ET greater at a distance. In addition, augmented MR recession should be considered for successful surgical outcomes when performing MR recession. These results and proposed surgical dosage guidelines might be helpful for strabismus surgeons in planning for the acquired comitant distance ET.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.