Lateral rectus superior plication using non-absorbable sutures for adult onset esotropia.

Introduction

divergence insufficiency esotropia is a common cause for acquired esotropia and diplopia in adults. We present a novel procedure, superior plication of the lateral rectus using non-absorbable sutures, to address this condition and analyze the surgical outcomes.

Methods

This is a retrospective cohort analysis. Adult patients operated on by a single surgeon for adult-onset esotropia between 1/2022 and 6/2023 were included. Demographic and medical histories, as well as measurements of deviation preoperatively and postoperatively were extracted and compared. Intraoperative and postoperative complications were noted.

Results

Included were 15 patients with a mean age of 51.1 ± 12.6 years, 67% were female and 67% were myopic. All underwent normal neuroimaging and negative myasthenia work up, and all reported diplopia. On last postoperative follow-up (mean 9.1 ± 6.1 months) only one case had manifest deviation. Overall mean distance deviation decreased from 25.7 ± 11 prism diopters (PD) to 0.16 ± 0.8 PD (p < .001) and near from 19.4 ± 16 PD to 0 ± 0 PD (p < .001). No patients had diplopia or required prisms postoperatively. Suture extrusion was documented in two cases, and one case of pyogenic granuloma was noted and was responsive to topical therapy. Discussion: This study presents a novel surgical procedure for the treatment of adult-onset esotropia. Among consecutive cases operated using the technique, one patient had mild esotropia on follow-up and no patients had diplopia. Minimal postoperative complications were noted, with suture extrusion being the most common. Superior lateral rectus plication appears to be a safe and reliable option for the treatment of adult-onset esotropia.