Seven-millimeter bilateral medial rectus recessions in infantile esotropia

Thirty-six patients with large angle infantile esotropia averaging 74 prism diopters underwent 7-mm bilateral medial rectus recessions by the cul-de-sac approach. Successful horizontal alignment with the initial procedure when measured at the most recent follow-up examination (average 18.2 months postoperatively) was achieved in 27 patients (75%). Five patients (14%) were undercorrected and four patients (11%) were over-corrected. The advantages of the method, as opposed to three or four muscle procedures, are that it is quicker, simpler, and a less traumatic procedure which leaves the lateral rectus muscles unoperated for future surgeries if necessary. This is effective even in very large angle congenital esotropia.