Long-term outcomes of medial rectus muscle recession for various types of esotropia.

PURPOSE: To evaluate the long-term outcomes of medial rectus muscle recession for various subtypes of esotropia and to identify preoperative factors associated with surgical success and postoperative alignment stability.

METHODS

This retrospective cohort study included pediatric patients (<15 years of age) who underwent unilateral or bilateral medial rectus muscle recession for infantile esotropia (IET), partially accommodative esotropia (PAET), acquired nonaccommodative esotropia (ANAET), or neurologic esotropia (NET), with a minimum postoperative follow-up of 3 years. The following data were collected: demographic and clinical characteristics, deviation angles, refractive errors, and postoperative alignment at multiple time points. Sensory outcomes were assessed using the Titmus stereo test and Worth Four-Dot test. Surgical outcomes were classified as success, undercorrection/recurrence, or overcorrection.

RESULTS

A total of 344 patients were included: IET, 114; PAET, 123; ANAET, 43; NET, 64. Mean age at surgery was 3.4 ± 2.2 years. The overall long-term success rate was 54%, with overcorrection rates of 39% in IET and 42% in NET groups. PAET demonstrated the lowest overcorrection rate (15%) but a progressive increase in recurrence over time. Younger age at onset, larger deviation angle, and presence of amblyopia were significantly associated with overcorrection. Postoperative sensory function was poorer in overcorrected patients, with only 11% achieving stereopsis better than 140 arcsec.

CONCLUSIONS

Overcorrection increased over time across all esotropia types, particularly in IET and NET. PAET patients also exhibited an increase in undercorrection/recurrence over time. Our findings underscore the need for individualized surgical strategies and extended follow-up, especially for patients with neurological impairments, abnormal binocular function, or accommodative components, to ensure stable alignment over time.