Unilateral lateral rectus advancement with medial rectus recession vs bilateral medial rectus recession for consecutive esotropia.

Background: To compare unilateral lateral rectus (LR) advancement with medial rectus (MR) recession with bilateral MR recession for patients with consecutive esotropia (ET).

Methods: Twenty-nine patients who developed consecutive ET of 30-35 PD following bilateral LR recession for intermittent exotropia were retrospectively reviewed. LR advancement into the original insertion site with 4.5 mm (30 PD ET) and 5.0 mm (35 PD ET) MR recession in the chiefly deviating eye was performed in 14 patients (A&R group). For 15 patients (BMR group), 4.5 and 5.0 mm bilateral MR recession was performed for 30 and 35 PD esodeviation respectively. As the primary outcome measure, postoperative ocular alignment between 5 PD of esophoria and 10 PD exophoria was considered a success.

Results: At 12 months postoperatively, successful surgical outcome was noticed in 12 patients (85.7%) in the A&R group and 11 patients (73.3%) in the BMR group. There was no statistically significant difference of final success rate between the A&R group and BMR group (p = 0.411). At 12 months after surgery for consecutive ET, seven (50%) and eight patients (53.3%) acquired binocular fine stereopsis ≤100 s of arc in the A&R and BMR groups respectively

Conclusions: Advancement of the previously recessed LR with recession of the MR in the chiefly deviating eye has a high success rate comparable to that of bilateral MR recession, with the advantage of preserving one MR muscle for potential future intervention.