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March 1986

Surgery for Large-Angle Congenital Esotropia: Two vs Three and Four Horizontal Muscles

Author Affiliations

From the Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City.

Arch Ophthalmol. 1986;104(3):374-377. doi:10.1001/archopht.1986.01050150074030

• Large-angle congenital esotropia is usually managed surgically by either of two fundamentally different approaches: (1) the uniform approach, in which surgery is restricted to two extraocular muscles (bimedial recessions or monocular recession-resection), or (2) the selective approach, in which bimedial recessions are combined with resections of one or both lateral rectus muscles. We compared surgical results of the two types of surgery during a ten-year period for 107 patients, of whom 57 underwent bimedial recessions, two had monocular recession-resections, and 48 received three- or four-muscle surgery. The average followup time was 2.6 years. The percentage of good surgical results (orthophoria ± 10 PD) in the selective group was 64.5%, compared with 37.3% in the uniform group. Only three of the 48 patients in the selective group required a second procedure, compared with 17 of 59 patients in the uniform group.

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