Bilateral Medial Rectus Recession Posterior to the Functional Equator in Esotropia Over 40 Prism Diopters

Hyung Jin Moon; Sang Woo Park; Yeoung Geol Park

doi:10.3341/jkos.2009.50.3.429

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Moon, Park, and Park: Bilateral Medial Rectus Recession Posterior to the Functional Equator in Esotropia Over 40 Prism Diopters

Original Article

J Korean Ophthalmol Soc 2009;50(3):429-434.

Published online: 31 August 2009

DOI: https://doi.org/10.3341/jkos.2009.50.3.429

Bilateral Medial Rectus Recession Posterior to the Functional Equator in Esotropia Over 40 Prism Diopters

Hyung Jin Moon, MD, Sang Woo Park, MD, Yeoung Geol Park, MD

Department of Ophthalmology, Chonnam National University Medical School & Hospital, Gwangju, Korea

Address reprint requests to Sang Woo Park, MD, PhD, Department of Ophthalmology, Chonnam National University Hospital #8 Hak-dong, Dong-gu, Gwangju 501-757, Korea Tel: 82-62-220-6753, Fax: 82-62-227-1642, E-mail: Exo70@ jnu.ac.kr

Received 20 March 2008 Accepted 21 October 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate bilateral medial rectus recession by considering functional equator as a surgical guideline in esotropia over 40 prism diopters (PD).

Methods

Forty-one patients who underwent bilateral medial rectus recession, and were followed-up for more than 12 months, were reviewed. The success rate was compared between group 1 and group 2, which were divided to recession site from the functional equator posterior, and also between the hyperopia group and myopia group according to refraction.

Results

According to preoperative deviation angle, 21 patients underwent recession to less than 10 mm posterior to the functional equator (group 1) and 20 patients had recession to 1.5 mm to 2.0 mm posterior to the functional equator (group 2). No significant difference in success rate between group 1 (71.4%) and group 2 (75.0%) was detected at the last follow-up. When divided into a hyperopia group (26 patients) and myopia group (15 patients), the success rate in the myopia group was higher than in the hyperopia group, as observed at the last follow-up, but the difference was not significant. There was 1 case of overcorrection in each group.

Conclusions

A successful outcome was achieved in 30 patients (73.2%), and overcorrection in 2 patients (4.9%) when recessed to 2.0 mm posterior to functional posterior in esotropia over 40PD.

Keywords: Axial length, Bimedial rectus recession, Esotropia over 40PD, Functional equator

References

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Figure 1.

Medial rectus recession amount according to deviation angle. The graph shows a positive relationship in medial rectus recession amount and deviation angle at near (r=0.619, p=0.01, by Spearman's rho).

Table 1.

Proposed surgical guideline

Preop.^* near deviation (PD^†)	Insertion site from functional equator (mm)
40	0.0 (functional equator)
45	0.5 posterior
50	1.0 posterior
55	1.5 posterior
> 55	2.0 posterior

^*Preoperative

^†Prism diopters.

Table 2.

Comparison of Group 1 and Group 2

	Group 1	Group 2	p-value^*
Sex (M/F)	1:1.57	1:1.60
Age (years)	5.28 (1-33)	5.80 (1-23)
Spherical equivalent (Diopter)	−1.50±6.84	−0.53±4.50	0.154
	(+4.75∼-28.00)	(+4.75∼-17.50)
Preoperative deviation (PD^†)
Near	47.62±8.46	57.75±10.82	<0.001
	(40.00∼50.00)	(55.00∼80.00)
Far	45.71±6.76	54.25±12.90	0.07
	(35.00∼50.00)	(30.00∼80.00)
Axial length (mm)	22.27±3.33	21.91±1.75	0.926
	(18.15∼33.65)	(19.55∼25.19)
Functional equator (mm)	11.19±2.23	10.97±1.06	0.835
	(8.12∼18.93)	(9.54∼13.02)
Recession site from functional equator posterior (mm)	0.29±0.31	1.54±0.46	<0.001
	(0.00∼1.00)	(1.50∼2.00)
Recession amount (mm)	6.68±2.16	7.47±1.20	<0.001
	(4.20∼14.00)	(5.00∼10.00)
Follow-up duration (months)	20.14±11.74	22.75±13.87
	(12-50)	(12-60)

^*Mann-Whitney U test

^†Prism diopters.

Table 3.

Success rate according to functional equator in esotropia

Follow-up period	Percent (Patients)		p-value^*
Follow-up period	Group 1 (21)	Group 2 (20)	p-value^*
1 month	81.0% (17)	80.0% (16)	0.623
3 months	76.2% (16)	80.0% (16)	0.534
6 months	76.2% (16)	75.0% (15)	0.607
Last follow-up	71.4% (15)	75.0% (15)	0.779

^*Fisher's exact test.

Table 4.

Comparison of hyperopia and myopia

	Hyperopia	Myopia	p-value^*
Sex (M/F)	1:1.44	1:1.37
Age (years)	3.58 (1∼19)	8.93 (1∼33)
Spherical equivalent (Diopter)	1.61±1.10	−5.56±7.59	<0.001
	(0.00∼+4.75)	(−28.00∼0.00)
Preoperative deviation (PD^†)
Near	52.12±8.46	53.00±11.77	0.968
	(40.00∼80.00)	(40.00∼80.00)
Far	51.35±10.91	47.33±11.00	0.142
	(35.00∼80.00)	(30.00∼80.00)
Axial length (mm)	21.03±1.33	23.94±3.37	<0.001
	(18.15∼24.58)	(20.10∼33.65)
Functional equator (mm)	10.39±0.82	12.26±2.27	<0.001
	(8.12∼12.59)	(10.12∼18.93)
Recession site from functional equator posterior (mm)	0.96±0.74	0.79±0.75	0.478
	(0.00∼2.00)	(0.00∼2.00)
Recession amount (mm)	6.59±1.16	8.05±2.30	<0.001
	(4.20∼10.00)	(5.30∼14.00)
Follow-up duration (months)	20.15±10.71	23.60±15.82
	(12.00∼48.00)	(12.00∼60.00)

^*Mann-Whitney U test

^†Prism diopters.

Table 5.

Success rate according to spherical equivalent in esotropia

Follow-up period	Percent (Patients)		p-value^*
Follow-up period	Hyperopia (26)	Myopia (15)	p-value^*
1 month	77.0% (20)	86.6% (13)	0.373
3 months	73.1% (19)	86.6% (13)	0.273
6 months	69.2% (18)	86.6% (13)	0.193
Last follow-up	65.4% (17)	86.6% (13)	0.132

^*Fisher's exact test.

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