Session: Free papers Session V - Esotropia 2

Horizontal three-muscle surgery for large esotropia

Background: Bilateral medial rectus muscle recession with or without Cüppers’ posterior fixation suture and recess and resect surgery are used to correct for large esotropia. There are only few reports on 3-muscle surgery (3MS). We analyzed results of 3MS.

Patients and methods: Between June 2016 and December 2023, 133 patients received 3MS for esotropia ≥27 deg. Additional oblique muscle surgery was performed, if needed. Simultaneous (SPCT) and alternating prism and cover testing (APCT) were performed at 5 m and 0.3 m. The mean total amount of surgery was about 0.5 mm/deg (APCT at 5 m). It was adapted to the individual axial eye length. Medium-term results of 80 patients were available at the time of abstract submission.

Results: Medians and ranges (min-max) were: Age, 6 years (3-56). Preoperative APCT at 5 m, 34 deg (27-45), at 0.3 m, 36 deg (27-50). Amount of surgery, 17 mm (15-21), oblique muscle recession in 30 cases. APCT after 5 months (3-24), far 2 deg (-10-18), near 2 deg (-8-18). Success rates (absolute deviation ≤6 deg), APCT 68% and 67% (5m and 0.3 m), SPCT 79% and 74%. Exotropia >6 deg at 5m occurred in 6 cases (7.5%), esotropia >6° remained in 20 cases (25%).

Conclusion: 3MS is a suitable first step procedure to correct for large esotropia in the analysed age range.