Strabismus Surgery in Orthophoric Patients with Abduction Limitation

Area of Science:

• Ophthalmology
• Strabismus Surgery
• Pediatric Ophthalmology

Background:

• Symptomatic esotropia in lateral gaze post-lateral rectus recession poses a surgical challenge, especially in orthophoric primary gaze patients.
• Existing literature lacks reports on surgical management for this specific condition.
• Concerns about inducing primary gaze diplopia often lead to withholding surgery.

Purpose of the Study:

• To report surgical outcomes for rare cases of esotropia in lateral gaze after lateral rectus recession.
• To describe a novel surgical approach and its effectiveness.
• To provide evidence supporting surgical decision-making in challenging strabismus cases.

Main Methods:

• Retrospective review of strabismus surgeries over 11 years at Boston Children's Hospital.
• Identification of orthophoric patients with lateral gaze diplopia post-lateral rectus recession.
• Assessment of surgical approach, pre/post-operative measurements, and outcomes using a new lateral incomitance (LI) score.

Main Results:

• Adjustable advancement of previously recessed lateral rectus muscles (2-3 mm) was performed.
• Early, transient exotropia was common but resolved.
• All patients achieved resolution of lateral gaze diplopia, with improved LI scores (8-18 PD) and no persistent primary gaze diplopia.

Conclusions:

• Small, adjustable lateral rectus muscle advancements yield excellent results for lateral gaze esotropia.
• The technique effectively resolves lateral gaze diplopia without causing persistent primary gaze issues.
• This approach supports surgical decision-making for complex strabismus management.