Convergence Insufficiency After Bilateral Medial Rectus Recession for Age-Related Distance Esotropia?

Area of Science:

• Ophthalmology
• Strabismus Surgery
• Oculomotor Function

Background:

• Age-related distance esotropia (ARDE) is a common condition requiring surgical intervention.
• Bilateral medial rectus (MR) muscle recession is a surgical technique used to correct ARDE.
• Postoperative outcomes, including ocular alignment and convergence function, are critical for patient quality of life.

Purpose of the Study:

• To evaluate postoperative exophoria and convergence insufficiency symptoms after bilateral MR recession for ARDE.
• To assess the long-term effects of this surgical procedure on ocular alignment and fusional reserves.

Main Methods:

• Retrospective case series analysis of patients with ARDE.
• Review of data for patients undergoing bilateral MR recession between September 2014 and October 2024.
• Analysis of preoperative and postoperative ocular deviations, convergence amplitudes, and patient-reported symptoms.

Main Results:

• 110 patients (mean age 74 years) were included.
• Postoperative exophoria at distance was observed in 7% and at near in 44% of patients, with no reported diplopia or near task difficulties.
• ARDE recurrence occurred in 20% of patients, with a higher rate of exophoria in the non-recurrence group at final follow-up.

Conclusions:

• Bilateral MR recession for ARDE is unlikely to induce convergence insufficiency.
• Long-term postoperative exophoria may serve as a protective factor against late recurrence of ARDE.
• The findings suggest a potential benefit of induced exophoria in managing ARDE long-term.