Bimedial rectus muscle elongation versus bimedial rectus muscle recession for the surgical treatment of large-angle infantile esotropia

Manar A Ghali Ophthalmology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt Purpose: To compare bimedial rectus muscle recession (BMRR; 7–8 mm) and bimedial rectus muscle elongation (BMRE; 6.5–9 mm) for the surgical treatment of large-angle infantile esotropia (ET; ≥70 prism diopters [PD]).Patients and methods: Twenty-four patients with large-angle infantile ET were divided into 2 groups; group A (n=12) underwent BMRR and group B (n=12) underwent BMRE. All patients received surgery under general anesthesia and were followed for at least 24 months after surgery. The mean dose-response effect at 24 months was calculated for each patient.Results: The mean preoperative angle of deviation was 79.16±7.64 PD (range, 70–90) in group A and 85.83±9.25 PD (range, 70–100) in group B. The duration of surgery was 55% shorter in group A compared with group B. There were no cases of over-correction, but there were 6 cases of under-correction in group A (50%) and 2 cases of under-correction in group B (16.7%). The mean dose-response effect was 4.42±0.19 PD/mm in group A and 5.45±0.39 PD/mm in group B.Conclusion: BMRE is more effective than BMRR for the surgical treatment of large-angle infantile ET despite a higher level of technical difficulty. Keywords: large-angle infantile esotropia, bimedial rectus muscle recession, bimedial rectus muscle elongation, surgical treatment of infantile esotropi