Lateral rectus superior plication using non-absorbable sutures for adult onset esotropia

Area of Science:

• Ophthalmology
• Surgical Innovation

Background:

• Divergence insufficiency esotropia is a frequent cause of acquired esotropia and diplopia in adults.
• Existing treatments may have limitations, necessitating novel approaches.

Purpose of the Study:

• To introduce and evaluate a new surgical procedure: superior plication of the lateral rectus using non-absorbable sutures.
• To analyze the surgical outcomes and complications associated with this novel technique for adult-onset esotropia.

Main Methods:

• Retrospective cohort analysis of adult patients with adult-onset esotropia operated on between January 2022 and June 2023.
• Comparison of preoperative and postoperative deviation measurements, including neuroimaging and myasthenia gravis workup.
• Documentation of intraoperative and postoperative complications.

Main Results:

• Fifteen patients (mean age 51.1 years, 67% female, 67% myopic) were included.
• Mean distance deviation decreased from 25.7 PD to 0.16 PD (p < .001); near deviation decreased from 19.4 PD to 0 PD (p < .001).
• One patient had residual mild esotropia; no patients experienced diplopia or required prisms postoperatively. Suture extrusion occurred in two cases.

Conclusions:

• Superior lateral rectus plication is a safe and effective surgical option for adult-onset esotropia.
• The technique leads to significant improvement in ocular alignment and resolution of diplopia.
• Suture extrusion was the most common complication, indicating a favorable safety profile.