Comitant strabismus

Variability in Response to Bilateral Medial Rectus Recessions in Infantile Esotropia

PURPOSE

To evaluate factors associated with surgical success in bilateral medial rectus recessions in infantile esotropia.

METHODS

The results of 97 patients with infantile esotropia undergoing surgical correction from January 2010 through December 2013 at Children's Medical Center of Dallas were reviewed. Multivariate logistic regression analysis of risk factors for success and evaluation of the relationship of surgical responses to baseline characteristics were performed.

RESULTS

The authors achieved an overall success rate of 59% (57 of 97 patients) with one surgery. At the time of surgery, preoperative angle, refraction, amblyopia, and simultaneous inferior oblique surgery were not significantly related to success or failure. The mean dose response was 3.61 ± 1.45 prism diopters per millimeter of surgery and was modestly correlated only with the preoperative deviation (r(2) = 0.32). Failure was associated with variability in dose-response, not inadequate or inconsistent with surgical dosing.

CONCLUSIONS

Surgical success with bilateral medial rectus recessions in infantile esotropia is limited by the high variability in surgical dose-response. [J Pediatr Ophthalmol Strabismus. 2016;53(5):305-310.].

Strabismus

Defining the type of strabismus creates a framework for work-up and management. Comitant esotropia is most commonly a childhood condition treated with glasses and surgery. Comitant exotropia is often a childhood condition that may require surgical correction. Microvascular disease is the most common cause of ocular cranial nerve palsies in adult patients.