Bilateral Medial Rectus Recession for Möbius Sequence Esotropia
Carolina H. Torres, MD; Mauro Goldchmit, MD
Instituto Strabos and Cema Hospital
São Paulo, SP, Brazil
Introduction: Möbius Sequence (MS) is a rare congenital anomaly of the brainstem. The minimum clinical diagnostic criteria is congenital, uni or bilateral, non-progressive facial paralysis and horizontal gaze palsy. Approximately 50% of the affected patients presents esotropia and strabismus correction is indicated in most of these cases.
Methods: Seventeen patients with MS who underwent strabismus surgery for esotropia were retrospectively reviewed. Patients presenting other strabismus patterns and with previous surgeries were excluded. Patients ages ranged from 1 to 18 yo (3,5 years average).
Results: The mean preoperative esotropia was 65 PD (range 35 to 100PD), medial rectus recess ranged from 5,5 to 11mm (8,5 mm average). The final horizontal alignment was orthotropia in 12 patients, 4 patients had residual esotropia of 10PD, 15PD, 20PD and 35PD; 1 had XT 8PD. Three patients required a second surgery to treat residual strabismus. The mean follow-up time was 50 months.
Discussion: Few studies discuss the surgical results of strabismus in MS. Previous authors have suggested lateral rectus resection and transposition of the superior rectus to treat large-angle esotropia in MS. In our study, patients were submitted to greater recessions than those previously described with good postoperative alignment of the eyes.
Conclusion: Large medial rectus recession alone is effective in treating MS esotropia.
References: 1. de Souza-Dias CR, Goldchmit M. Further considerations about the ophthalmic features of the Möbius sequence, with data of 28 cases. Arq Bras Oftalmol 2007;70:451–7
2. Spierer A, Barak A. Strabismus surgery in children with Mobius syndrome. J AAPOS. 2000;4(1):58-9.
3. Sun LL, Gole GA. Augmented vertical rectus transposition for the treatment of strabismus in Mobius syndrome. J AAPOS. 2011;15:590-592.