Large bilateral medial rectus recession versus three-to-four horizontal muscle surgery for large-angle esodeviations

The best surgical approach to correcting large angle esodeviations is still debated. Options for correcting large esodeviations include recessing both medial rectus (BMR) muscles more than 5.5 mm or performing surgery on three or four horizontal rectus muscles. There remains no consensus on which surgery has better survival outcomes. In this research, we are interested in determining the survival rates and long-term outcomes of both surgeries locally in the Philippines.

A total of 74 medical records were retrospectively reviewed. The mean age at onset of deviation was 2  ±  2.9 years old, and the mean age at surgery was 14  ±  12.5 years, with a mean of 12  ±  12.1 years from onset to surgery. The mean follow-up period was 9.9 months (range 6-24) . The mean preoperative deviation at near was 59.3  ±  13.6 PD (range: 35-95) while at distance was 58.5  ±  13.6 PD (range 10-95). The most common type of esotropia (ET) was infantile ET (45%), followed by basic ET. Majority of the esodeviations did not have associated vertical strabismus (67.6%, n  =  50). Overall success rate was 48.1% for BMR recessions and 54.5% for 3-4 muscles surgery. Survival analysis revealed the decreasing trends of survival but plateauing of outcomes after 6 months.

We reported the outcomes for both surgeries. Neither had shown superiority over the other. After a mean follow up of 9.9 months, the overall success was relatively good: 50% were successful, 39.2% overall recurrence and 13.8% overcorrections. Survival plots showed a plateauing of results after 6 months.