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

This study evaluated postoperative exophoria and symptoms of convergence insufficiency following bilateral medial rectus (MR) muscle recession performed for correction of age-related distance esotropia (ARDE).

Retrospective case series.

Data were reviewed for patients with ARDE without neurological diseases who underwent bilateral MR recession between September 2014 and October 2024.

Included were 110 patients of mean age 74 ± 9 (standard deviation) years. Preoperative esotropia was 13 ± 8∆ at distance and 4 ± 6∆ at near. Preoperative convergence fusional amplitude was 27 ± 12∆. Bilateral MR recession was combined with vertical rectus surgeries in 28 (25%) patients. At the final follow-up after a mean of 14 months, 8 (7%) patients exhibited exophoria at distance. Exophoria was present at near in 48 (44%) patients, including 8 in whom exophoria exceeded 10∆. However, none of these exophoric patients reported symptomatic diplopia or difficulty with near tasks at any time. At final follow-up, ARDE recurred in 22 patients (20%). Mean initial postoperative near deviation did not differ between groups (-2.0∆ vs -2.4∆, P = .77). However, at final follow-up, the nonrecurrence group had significantly more exophoria than the recurrence group (-2.5∆ vs -0.1∆, P = .02). Survival analysis demonstrated approximately 15% recurrence rate of ARDE 2.5 years after surgery, increasing at 5 years postoperatively to 40%.

Bilateral MR recession for ARDE is unlikely to cause convergence insufficiency, but long-term postoperative exophoria after this procedure may protect against late recurrence of ARDE.