Augmented-Dose Unilateral Recession-Resection Procedure in Acute Acquired Comitant Esotropia

Purpose: To compare the surgical amount of unilateral medial rectus recession and lateral rectus resection (RR) in patients with acute acquired comitant esotropia (AACE) versus common forms of esotropia and to provide dose-response reference for surgical planning in AACE. Participants: Consecutive patients who underwent unilateral RR for AACE or common forms of esotropia correction from January 2018 to January 2022. Only patients who achieved motor and sensory success with a minimum follow-up of 3 months were analyzed. Methods: Group differences in the amount of medial rectus (MR) recession and lateral rectus (LR) resection were analyzed using multivariate regression models. Surgical dose responses in AACE were analyzed using multivariable regression models. Regression models were performed with and without adjustment for clinical confounders. Piecewise analysis was used to detect segmented results. Main Outcome Measures: Group difference in surgical amount and dose responses of unilateral RR in Results: Fifty-four patients with AACE and 98 patients with common forms of esotropia were included. To correct comparable deviations, surgical amount performed was significant larger in AACE patients, with the adjusted group differences of 0.49 mm (95% confidence interval [CI], 0.34-0.65 mm; P < 0.001) in MR recession and 1.68 mm (95% CI, 1.25-2.11 mm; P < 0.001) in LR resection in patients with deviation < 40 prism diopters (A) and with a group difference of 1.22 mm (95% CI, 0.76-1.68 mm; P < 0.001) in LR resection in those with deviation > 40 A. In AACE patients, in the adjusted model taking into account the intercept, dose responses of MR recession and LR resection in patients with deviation < 30 A were 5.11 A/mm (95% CI, 0.98-9.23 A/mm; P = 0.02) and 2.51 A/mm (95% CI, 0.57-4.45 A/mm; P = 0.02), respectively, and for those with deviation > 30 A, the dose response of additional LR resection was 5.48 A/mm (95% CI, 4.56-6.40 A/mm; P < 0.001) to correct remaining deviation beyond 30 A. Conclusions: These findings provide quantitative evidence that augmented-dose unilateral RR should be performed in AACE for favorable surgical outcomes. The new surgical dose calculation proposed provides reference for surgical planning. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. Ophthalmology 2023;130:525-532 (c) 2022 by the American Academy of Ophthalmology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).