Session: Free papers Session V - Esotropia 2

Lateral Rectus Superior Plication Using Non-Absorbable Sutures for Divergence Insufficiency Esotropia

Background: Divergence insufficiency esotropia, resulting from the downward displacement of the lateral recti (LR), is a frequent cause of diplopia in adults. Conventional surgical interventions like bi-medial recession (BMR) or LR resection often yield late under-correction. We introduce a novel approach: superior plication of the LR using non-absorbable sutures, coupled with a single medial rectus recession on adjustable sutures. This procedure aims to rectify the LR's downward sagging and produce stable long-term results.

Methods: This retrospective study encompassed all patients operated on by a single surgeon for divergence insufficiency esotropia between January 2021 and June 2023. We recorded pre- and post-operative measurements, along with intraoperative and postoperative complications.

Results: Our cohort consisted of 24 patients with acquired esotropia and diplopia, aged 13 to 77 years (mean 41.9±16 years). 58% were female, and 87% were myopic. Three had previously undergone BMR. Neuroimaging confirmed the downward LR shift, and myasthenia tests were negative. All patients underwent 3-5mm superior plication of both LR muscles using non-absorbable sutures. In one eye, the medial rectus was placed on adjustable suture. In seven cases it was recessed 2-4mm within 24 hours postoperatively. After an average follow-up of 21.70±6.5 months, all patients achieved orthophoria, except one who had 6PD esophoria for distance. No cases of diplopia were reported. Two patients experienced suture extrusion, which was treated in-office.

Conclusions: This study introduces an innovative surgical procedure for addressing divergence insufficiency esotropia. Our consecutive cases demonstrated minimal manifest deviation and diplopia during follow-up, along with minimal postoperative complications.