Supramaximal Recession and Resection Surgery in Large-Angle Strabismus

Abstract

Purpose: To assess the postoperative surgical outcomes and the changes in deviation in patients treated by supramaximal recession and resection (R&R) of rectus muscles to correct the large-angle exotropia and esotropia. Methods: This study was a prospective interventional case series, and patients with esotropia of ≥65 prism diopter (PD) or exotropia of ≥60 PD who had undergone supermaximal R&R in non-fixating eye with lower vision in unilateral strabismus or bilateral medial rectus (BMR) recession up to 8.5 mm for esotropia and bilateral lateral rectus (BLR) recession up to 12.5 mm for exotropia in bilateral strabismus were enrolled. Successful results were achieved if postoperation deviation was <10 PD for esotropia and <15 PD for exotropia during their final examinations. Results: A total of 131 cases (48 patients with esotropia and 83 patients with exotropia) were included. The mean ages of the patients with esotropia and exotropia were 16.83 ± 15.06 and 23.19 ± 11.29 years, respectively. The mean preoperative esodeviations for bilateral and unilateral surgeries were 69.5 ± 6.5 and 80.7 ± 10.3, respectively, and these values for bilateral and unilateral exodeviations surgeries were 67.3 ± 7.6 and 74.2 ± 12.1, respectively. The overall successful outcomes were achieved in 50% of the esotropic patients and 79.5% of the exotropic patients. At final follow-up examination, no patient had diplopia on lateral gazes. Conclusion: Based on our surgical results, it is possible to consider monocular recession-resection surgery in non-fixating eye (with poor vision) or BLR and BMR recession in both eyes as a viable option for surgical treatment of large angles deviations.

Botulinum toxin augmented surgery versus conventional surgery in the management of large-angle concomitant esotropia: A randomized clinical trial

“…Surgical management of large angle esotropia has been always challenging and associated with high reoperation rates. [ 3 4 ] Surgical options for these patients have included large bimedial rectus recessions,[ 5 ] supramaximal unilateral recession resection procedure,[ 6 ] three or four horizontal muscle surgery,[ 7 ] or botulinum toxin A (BTA) augmented surgery. [ 8 ]…”

“…[ 5 ] Unilateral supramaximal recession resection procedures carry a high risk of lateral incomitance and palpebral fissure narrowing. [ 6 ] Three or four horizontal muscle surgery has good outcomes but has the disadvantage of longer surgical time and increased risk of surgical complications. [ 7 9 ]…”