Medial Rectus Disinsertion for the Management of Large-Angle Sensory Esotropia

TL;DR

This study reports on using a medial rectus disinsertion procedure to manage large-angle eye misalignment in patients who refuse surgery on the opposite eye.

Contribution

The study introduces medial rectus disinsertion as a potential treatment for large-angle sensory esotropia when surgery on the opposite eye is not an option.

Findings

The procedure reduced the angle of esotropia from 92.0 ± 17.9 PD to 38.0 ± 29.5 PD.

Abduction deficiency improved from −4 to −1 at the last follow-up.

The results were better than expected, suggesting the procedure could be a viable option.

Abstract

Background and Objectives: The aim of the report is to report the outcomes of the medial rectus (MR) disinsertion procedure for the management of large-angle esotropia (ET) patients. Materials and Methods: This is a retrospective case series of patients with large-angle ET who underwent an MR disinsertion procedure between March 2012 to April 2022. The procedure happened accidentally during muscle surgery. The demographic and clinical data, including sex, age, visual acuity, pre- and postoperative angle of strabismus, duction limitations, results of intraoperative forced duction tests, and follow-up duration were collected from medical records. Results: Five patients were enrolled in this study. The mean age was 62.2 ± 9.8 years, and the mean follow-up was 24.8 ± 8.7 months. The ET at the primary position of gaze was 92.0 ± 17.9 prism diopters (PD) before MR disinsertion and 38.0 ± 29.5 PD after MR disinsertion only. Abduction deficiency was −4 before after MR disinsertion, which improved to −1 at the last follow-up. Conclusions: The results of MR disinsertion were not as frustrating as anticipated. MR disinsertion may be considered in patients with large-angle sensory ET who refuse surgery on the opposite eye.

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