Combined resection–recession versus combined recession–retroequatorial myopexy of medial rectus muscles for treatment of near-distance disparity Esotropia

PURPOSE To compare and evaluate the efficacy of two different surgical techniques for the treatment of near-distance disparity esotropia; combined resection-recession and recession-retroequatorial myopexy of medial rectus muscles. PATIENTS AND METHODS This prospective study included 28 patients diagnosed with convergence excess esotropia who had worn their full cycloplegic refraction and/or bifocal glasses for at least 6 months and still had near-distance disparity esotropia. The patients were divided into 2 groups; Group I underwent combined bimedial rectus muscles resection 2.5 mm from the insertion end with recession based on near-angle esotropia according to current surgical tables with 1 mm add of recession for each muscle, while Group II underwent bimedial recession based on far angle combined with retroequatorial myopexy at 13-14 mm from insertion. A satisfactory result was defined as orthophoria or esotropia <10 prism diopters (Δ) at near and distance with reduction of the near-distance disparity to <10 Δ. The patients were followed up for at least 2 years for stability of correction and late onset consecutive exotropia. RESULTS In Group I, all the patients had satisfactory alignments at near and far with residual near-far disparity #10 Δ, no cases of overcorrection at far was reported; while in Group II, all cases had orthophoria at far, but 4 cases (28.6%) showed near-far disparity >10 Δ. CONCLUSION The technique of combined resection-recession is safe, easy and more effective in the treatment of near-distance disparity esotropia regardless of the level of accommodative convergence/accommodation ratio, with stability of results though longer follow-up period is still needed.