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Combined resection–recession versus combined recession–retroequatorial myopexy of medial rectus muscles for treatment of near-distance disparity Esotropia

Authors Ghali MA

Received 13 March 2017

Accepted for publication 20 April 2017

Published 6 June 2017 Volume 2017:11 Pages 1065—1068

DOI https://doi.org/10.2147/OPTH.S136879

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Manar A Ghali

Ophthalmology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt

Purpose: To compare and evaluate the efficacy of two different surgical techniques for the treatment of near-distance disparity esotropia; combined resection–recession and recession–retroequatorial myopexy of medial rectus muscles.
Patients and methods: This prospective study included 28 patients diagnosed with convergence excess esotropia who had worn their full cycloplegic refraction and/or bifocal glasses for at least 6 months and still had near-distance disparity esotropia. The patients were divided into 2 groups; Group I underwent combined bimedial rectus muscles resection 2.5 mm from the insertion end with recession based on near-angle esotropia according to current surgical tables with 1 mm add of recession for each muscle, while Group II underwent bimedial recession based on far angle combined with retroequatorial myopexy at 13–14 mm from insertion. A satisfactory result was defined as orthophoria or esotropia <10 prism diopters (∆) at near and distance with reduction of the near-distance disparity to <10 ∆. The patients were followed up for at least 2 years for stability of correction and late onset consecutive exotropia.
Results: In Group I, all the patients had satisfactory alignments at near and far with residual near–far disparity ≤10 ∆, no cases of overcorrection at far was reported; while in Group II, all cases had orthophoria at far, but 4 cases (28.6%) showed near–far disparity >10 ∆.
Conclusion: The technique of combined resection–recession is safe, easy and more effective in the treatment of near-distance disparity esotropia regardless of the level of accommodative convergence/accommodation ratio, with stability of results though longer follow-up period is still needed.

Keywords:
near-distance disparity, esotropia, Ac/A ratio, retroequatorial myopexy, slanted recession

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