Adjustable horizontal rectus recession surgery for disparate distance-near ocular deviations

Strabismic deviations which display incomitance changing from distance fixation to near fixation are the result of many disturbances of both the supranuclear and infranuclear ocular motor system. This report details the surgical treatment and outcome of 6 patients with disparate distance-near deviations due to different etiologies. The surgical procedure involves recessing all four horizontal recti on both eyes using the adjustable suture technique. The approach to surgery consisted of operating on the vergence angle with the larger deviation with a bilateral lateral rectus recession (BLREC) or a bilateral medial rectus recession (BMREC) and simultaneously operating on the smaller vergence angle, treating the total induced deviation with the bilateral recession not used first (remaining BLREC or BMREC). All patients had a significant decrease in their distance-near disparity, increased horizontal comitance, normalization of their accommodative convergence to accommodation ratios, and resolution of diplopia. A four horizontal recti muscle, adjustable suture recession is another technique that can be added to the treatment regimens for distance-near disparity strabismic syndromes.