[Bilateral medial rectus recession with posterior fixation suture for large infantile esotropia]

Surgery for infantile large angle esotropia is not uniform. Bilateral medial rectus recession (BMR), combined recess-resect procedure, also combined with simultaneous contralateral medial rectus recession or secondary other procedures are common. Alternatively, bilateral medial rectus recession with posterior fixation suture (BMRF) has been used. We analysed the effect of BMRF for this specific indication.

We undertook a retrospective evaluation of squint angles in simultaneous (S) and alternating (A) prism cover test before and 3 months after BMRF with and without additional oblique muscle surgery as primary surgery for esotropia ≥ 20° performed at our department between 1997 and 2009, as well as the rate of second procedures.

Sixty-one children (0.5 % of all patients who received eye muscle surgery during the same time interval) were included. Medians (10 % and 90 % quantiles) were: age at surgery 48.4 months (23.6; 76.0), refraction (spherical equivalent)2.25 dpt (0.25; 5.50), posterior fixation 5.5 mm + 13.0 mm (12.5; 13.0) from limbus, recession 5.0 mm (4.0; 5.0), inferior oblique recession in 29 children (27 bilateral), preoperative squint angles at 5 m S/A 29° (20; 40), at 0.3 m S/A 35° (24; 45), postoperative at 5 m S 0° (-6; 10), A 2° (-6; 11), at 0.3 m S 1° (-5; 12), A 3.5° (-5; 13), S ≤ 5° in 70.2 % at 5 m and 60.3 % at 0.3 m, consecutive exotropia 6-10° and > 10° in 7.0 and 3.5 % at 5 m and 8.6 and 1.7 % at 0.3 m, residual esotropia 6-10° and > 10° in 10.5 and 8.8 % at 5 m and 13.8 and 15.5 % at 0.3 m. Seven children (11.5 %) were re-operated for esotropia, four for exotropia (6.6 %).

Bilateral medial rectus recession with retroequatorial myopexy (Cüppers procedure) is an effective one-step procedure for large infantile esotropia. In roughly two-thirds of the cases, the squint angle was corrected within ± 5° with one surgery, which is similar to reported success rates of BMR.