Lateral rectus advancement versus medial rectus recession for consecutive esotropia

The long-term surgical outcomes of lateral rectus advancement in consecutive esotropia

PURPOSE

To evaluate the long-term surgical efficacy of lateral rectus advancement (LRadv) in patients with consecutive esotropia (CET).

METHODS

The medical records of 30 patients who developed CET after bilateral lateral rectus (BLR) recession for exotropia (XT) between 2012 and 2020 were reviewed. The characteristics of patients during their XT surgery were summarized. Among them, 15 patients who underwent LRadv as CET treatment with at least a 1-year follow-up were included to evaluate the long-term efficacy of this surgical approach. The main outcomes were the pre- and post-operative angle of deviation after LRadv. Surgical success was defined as the postoperative deviation within 10 prism diopters (PD), and reoperation was not needed. All data were expressed as median and interquartile ranges.

RESULTS

The median follow-up was 34 months after LRadv surgery. The median postoperative deviation ranged from 28 to 1 PD at 1 year (P < 0.05) and to 5 PD at the final follow-up (P < 0.05). The deviation at each follow-up time showed no statistically significant difference (P > 0.05). The final surgical success was reduced compared to 1 day and 1 year postoperatively (60% VS 100% and 66.7%, respectively). Undercorrection and overcorrection both occurred at the final follow-up.

CONCLUSION

Although the immediate surgical outcome of LRadv was satisfactory, the success rate reduced with time, which suggests long-term observation is necessary to detect and timely provide appropriate interventions for overcorrection or undercorrection.

Consecutive Esotropia with and without Abduction Limitation - Risk Factors and Surgical Outcomes of Lateral Rectus Advancement

Purpose: To identify risk factors for abduction limitation in consecutive esotropia following surgical correction of exotropia. To study outcomes of lateral rectus advancement for consecutive esotropia correction.Methods: Patients with consecutive esotropia (>10PD) operated between 2007 and 2019 with a minimum follow-up of 2 months were reviewed retrospectively. Preoperative and postoperative alignment and ocular motility were recorded. Patients were classified into those with full abduction (group-A) and with abduction limitation (group-B). Success was defined as deviation ≤10 PD of esotropia or exotropia in the primary position.Results: Forty-cases fulfilled the inclusion criteria (group-A = 28 and group-B = 12). Median age at surgery was five years, median consecutive esotropia was 20PD and follow-up was 29.18 months. Abduction limitation (group-B) was associated with constant exotropia (p = .01) and larger bilateral lateral rectus recession (group-A = 13 mm, group-B = 15 mm; p = .04). Nineteen patients underwent lateral rectus advancement (group-A = 12, group-B = 7), one underwent medial-rectus recession and two were excluded due to lack of postoperative follow-up. Five patients had spontaneous resolution with good alignment (group-A = 3, group-B = 2), two refused surgery, three were observed and eight were lost to follow-up. Success following second surgery was similar in both groups (group-A = 86%, group-B = 77%)(p = 1).Conclusion: Constant exotropia and larger lateral rectus recession were associated with abduction limitation in consecutive esotropia. Lateral rectus advancement produced good outcomes irrespective of abduction limitation.