Bilateral medial rectus muscle recession: results in children with developmental delay compared with normally
Zohar Habot-Wilner1, Abraham Spierer, Joseph Glovinsky
1Goldschleger Eye Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel.
Insights
Children with developmental delay have lower success rates after bimedial rectus (BMR) surgery for esotropia. Undercorrection was the main reason for failure in this group, suggesting a need for adjusted surgical amounts.
Area of Science:
- Ophthalmology
- Pediatric Strabismus Surgery
Background:
- Esotropia is a common form of strabismus in children.
- Developmental delay can impact surgical outcomes for various conditions.
- Bimedial rectus (BMR) recession is a standard surgical approach for esotropia.
Purpose of the Study:
- To compare the surgical outcomes of bimedial rectus (BMR) recession for esotropia in children with and without developmental delay.
- To identify factors contributing to surgical success or failure in these groups.
Main Methods:
- Retrospective analysis of pediatric patients undergoing BMR surgery for esotropia over a 10-year period.
- Comparison of surgical outcomes between children with developmental delay and those without.
- Analysis of pre-operative deviation, amount of recession, and post-operative alignment.
Main Results:
- Developmentally delayed children had a higher rate of surgical failure (44%) compared to typically developing children (6%).
- Undercorrection was the primary cause of failure in the developmentally delayed group, with a smaller mean recession amount used.
- Typically developing children achieved a 94% success rate with standard recession amounts.
Conclusions:
- Bimedial rectus recession for esotropia yields lower success rates in children with developmental delay.
- Undercorrection is a significant issue in this population, potentially due to reduced recession amounts.
- Further research is needed to establish optimal surgical parameters for developmentally delayed children with esotropia.
Purpose:
We sought to compare bimedial rectus muscle recession (BMR) results for esotropia in children with developmental delay with the results in normal children.
Methods:
A retrospective analysis of all the children that underwent standard BMR surgery for esotropia during a 10 year period was undertaken. The surgical results of children with developmental delay were compared with those of normal children.
Results:
In the developmentally delayed group, the mean angle of esotropia before surgery was 53+/-12 PD, the mean amount of medial rectus recession was 5.4+/-0.56 mm, 0.84 mm less than the standard amount of recession, and at the last follow-up visit only 56% achieved surgical success (within 10 PD of orthophoria). Among the failures, 86% were undercorrected, only one patient developed consecutive exotropia after surgery. In the developmentally intact group, the mean angle of esotropia before surgery was 37.4+/-8 PD, the mean amount of medial rectus recession was 5.2+/-0.65 mm, and 94% achieved surgical success. Among surgical failures, we observed only a single case of overcorrection.
Conclusion:
A higher rate of surgical failure was found in developmentally delayed children who received a smaller recession amount of the medial rectus muscles when compared with the developmentally normal children who received a standard amount of recession. The main reason for surgical failure in the developmentally delayed group, in a follow-up period of 2 years, was undercorrection of the angle of esotropia. It seems that decreasing the surgical table by a certain amount in children with developmental delay may lead to undercorrection. Therefore, we need to delineate the ideal amount of surgery in this unique group of individuals.
