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Bulgarian Review of Ophthalmology

Surgical treatment of large angle esotropia

G. Dimitrova


Aim: To evaluate the effect of large medial rectus muscle recessions in the attempt to operate on less muscles in large angle esotropia.

Material and methods: This is a retrospective study including 200 children (370 eyes), operated on for esotropia in the period of 2000-2014 by one and the same surgeon. One hundred and seventy of them (340 eyes) underwent bilateral medial rectus muscle recessions and 30 - unilateral medial rectus muscle recession for various forms of alternating esotropia. We evaluated the effect of corrected priam diopters for each mm of recession (Δ/mm recession) and the target angle was determined by alternate prism cover test alone or by maximum motor fusion test.

Results: The mean effect corrected prism dioptres for each mm of recession (Δ /mm) was in a direct proportion to the amount of retroplacement (p<0.001). Only 6% of our patients needed a second surgery (a lateral rectus muscle resectipon) for a residual angle.

Conclusion: The larger the recession, the bigger the effect of corrected prism dioptres for each mm of retroplacement. Thus large bilateral medial rectus muscle recessions can correct successfully large angle esotropia and give similar results to surgery of three or four muscles.


large medial rectus muscle recession; esotropia treatment; target angle

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About The Author

G. Dimitrova
Medical University - Sofia, Faculty of Medicine, Department of Ophthalmology University Hospital `Alexandrovska`, Sofia, Bulgaria