Surgical outcomes of Scott 2:1 recession-resection adjustable technique for incomitant strabismus

Surgical management of incomitant strabismus, characterized by gaze-dependent misalignment, is challenging. The Scott procedure, which involves the combined recession-resection of the same extraocular rectus muscle, avoids posterior scleral suturing beyond the globe's equator and allows for postoperative adjustment. However, long-term outcomes and optimal surgical dosing remain unclear. This study is the largest series to date that reports outcomes of a 2:1 same-muscle recession-resection dosing strategy.

A retrospective chart review (January 2014 to August 2024) identified patients with ≥5^Δ difference between primary and diplopic gazes who underwent a 2:1 Scott procedure. All procedures were performed by a single surgeon at a tertiary referral center.

Thirty-five patients met inclusion criteria, including 16 (46%) with prior strabismus surgery. The inferior rectus muscle was most commonly treated (n = 16), followed by the medial rectus (n = 11), lateral rectus (n = 8), and superior rectus (n = 2) muscles. The amount of recession and resection was 5.3 ± 1 mm and 2.5 ± 0.5 mm, respectively. Preoperative incomitance improved from 9.5^Δ ± 6^Δ to 1^Δ ± 2^Δ (P < 0.0001) in 34 of 35 patients (97%). Improvement in incomitance was comparable across rectus muscles (P = 0.5) and between small and large (<10^Δ and ≥10^Δ) preoperative incomitance (P = 0.48). Four patients (12.5%) required reoperation, with no increased reoperation risk related to strabismus surgical history or degree of preoperative deviation/incomitance.

In this patient cohort, the 2:1 dosage for same-muscle recession-resection demonstrated significant improvement in incomitance across various rectus muscles, preoperative deviations, and history of strabismus surgery. This approach provides surgeons with a straightforward and pragmatic means to manage incomitant strabismus.