Surgery for large-angle congenital esotropia. Two vs three and four horizontal muscles
W. E. Scott, P. D. Reese, C. R. Hirsh and C. A. Flabetich
Large-angle congenital esotropia is usually managed surgically by either of
two fundamentally different approaches: (1) the uniform approach, in which
surgery is restricted to two extraocular muscles (bimedial recessions or
monocular recession-resection), or (2) the selective approach, in which
bimedial recessions are combined with resections of one or both lateral
rectus muscles. We compared surgical results of the two types of surgery
during a ten-year period for 107 patients, of whom 57 underwent bimedial
recessions, two had monocular recession-resections, and 48 received three-
or four-muscle surgery. The average follow-up time was 2.6 years. The
percentage of good surgical results (orthophoria +/- 10 PD) in the
selective group was 64.5%, compared with 37.3% in the uniform group. Only
three of the 48 patients in the selective group required a second
procedure, compared with 17 of 59 patients in the uniform group.
