Primary Bilateral Medial Rectus Resections in Large Angle Childhood Exotropia
Cristiana Soares Ronconi, MD; Bruna Lana Ducca, MD; Dayane C. Issaho, MD; David R. Weakley, Jr., MD
University of Texas Southwestern
Introduction: Traditional surgical approaches for large-angle exotropia often result in undercorrection, abduction deficits and/or incommittance. We report results with primary bi-medial rectus resections previously reported only in adults.
Methods: Retrospective review of children undergoing primary medial rectus resections for childhood exotropia from 2012 to 2016 with minimum 3 months follow-up.
Results: Thirty-two patients underwent primary bi-medial rectus resections (median age 58 mos (range 6 mos-15 yrs) for a mean exotropia of 52PD (range 40 -70PD) distance and 51.4 PD (range 40-65PD) near. Mean resection was 6.3 mm per muscle (range 5.75-8mm) The mean correction was 39.8 PD distance and 37.4 PD near at last follow-up (mean 18 mos., range 3-51 mos). Mean dose response was 3.14PD/mm resection distance and 2.97 PD/mm at near. Success (< 10PD residual deviation), was achieved in 59% of patients at last follow-up, none were esotropic. No significant incommittance or abduction defects were noted at last follow-up.
Discussion: Success with primary bi-medial rectus resections compare favorably to large bilateral lateral rectus recessions and monocular recession-resection procedures for large angle exotropia in childhood avoiding potential abduction deficits or incommittance seen with other procedures. Increasing resection amounts based on observed dose-response in this study will likely improve outcomes further.
Conclusion: Primary bi-medial rectus resection should be considered in children with large angle exotropia.
References: ElKamshoushy AA. Bilateral medial rectus resection for primary large angle exotropia. J AAPOS. 2017 Apr;21(2):112-116
Berland JE, Wilson ME, Saunders RB Results of large (8-9 mm) bilateral lateral rectus muscle recessions for exotropia. Binoc Vis Strabismus Q 1998:13:97-104