Surgical management of large angle congenital esotropia

SUMMARY Ninety-seven patients with congenital esotropia with deviations of 50 prism dioptres or greater underwent large (6 and 7 mm) bimedial rectus recessions. The overall success rate with one operation was 83-5%. Judgment of final alignment was made at the last follow-up examination, six to 61 months (average 23-4 months) postoperatively. Large bimedial rectus recessions for congenital esotropia are an effective surgical treatment which does not significantly alter adduction. The best surgical treatment of large angle congenital esotropia continues to be controversial. Success rates ranging from 40 to 80 % have been described with a variety of surgical techniques. " Traditionally the maximum recession of the medial recti has been approximately 5 mm.7 Several investigators have successfully corrected large angle esotropia with bimedial rectus recessions in excess of the traditional 5 mm." " Mittleman and Folk have presented favour-able results following re-recession of the medial rectus 13*5 mm from the limbus for undercorrected esotropia." In a preliminary report we showed a 91 % success rate with 6 or 7 mm bimedial rectus recessions in 45 congenital esotropes with deviations of 50 prism dioptres or greater. 12 Judgment of final alignment was made six weeks postoperatively, with an average follow-up of 13 months. This report presents the long term follow-up of 6 and 7 mm bimedial recessions for the treatment of large angle congenital esotropia. Material and methods The records of 321 patients with congenital esotropia who underwent surgery at the Pediatric Ophthal