Lateral rectus advancement versus medial rectus recession for consecutive esotropia

Purpose: To compare lateral rectus advancement with medial rectus recession for patients with consecutive esotropia without abduction limitation. Methods: Forty-three patients who developed consecutive esotropia following bilateral lateral rectus recession for intermittent exotropia were reviewed retrospectively. Twenty-two patients underwent lateral rectus advancement (lateral rectus advancement group) and medial rectus recession was performed in 21 patients (medial rectus recession group). Success rate of the surgery was based on the percentage of postoperative esophoria or exophoria of less than 8 PD, which did not require a third surgery. Mean follow-up after second surgery was 23.5 +/- 8.7 months. Results: Mean consecutive esotropia in the lateral rectus advancement group was 24.8 +/- 9.0 PD. Eight patients were orthophoric after second surgery; mean postoperative esophoria and exophoria/tropia was 5.4 +/- 3.4 PD and 6.5 +/- 5 PD, respectively. Postoperative success rate in this group was 90.9%. Mean consecutive esotropia in the medial rectus recession group was 21 +/- 98.4 PD. Three patients were orthophoric after second surgery; mean postoperative esotropia/phoria and exophoria was 9.5 +/- 5.0 PD and 5.2 +/- 1.3 PD, respectively. Postoperative success rate in this group was 71.4%. Postoperative undercorrection rate of 4.5% in lateral rectus advancement group was significantly less than the similar measure of 28.6% in medial rectus recession group (chi-square, P = 0.03). Conclusion: Advancement of the previously recessed lateral rectus has improved consecutive esotropia better than medial rectus recession.