Unilateral four-recti muscle surgery in large angle sensory esotropia.

Abstract

Background: Large angle sensory esotropia is difficult to treat, as it often requires multiple surgeries. Four-muscle surgery in one eye is rare as there is an elevated risk of anterior segment ischaemia. Anterior segment ischaemia occurs as disinsertion of multiple recti muscles reduces blood supply to various ocular anterior segment structures. We present a case of a successfully treated unilateral, staged, four-muscle surgery.

Methods: Case Report

Results: A 33-year-old female presented with a longstanding, large angle, left eye (LE) constant esotropia and dense amblyopia secondary to high myopia. Pre-operatively, she had LE esotropia of more than 133 prism diopters (PD) with LE abduction deficit of -4. In view forced-duction test was positive intra-operatively, she underwent maximum LE medial rectus recession. Post-operatively, her esotropia reduced to 133 PD. Two months later, the patient had LE medial rectus re-recession and modified Nishida’s procedure. The esotropia reduced to 60PD with LE abduction deficit of -3. One year later, LE lateral rectus plication was performed. The patient’s final angle at 6 months follow-up was 25 PD with an abduction deficit of -3. She had no evidence of anterior segment ischaemia and was happy with the final surgical outcome.

Conclusion: Four-muscle surgery in one eye is an option for large angle sensory esotropia. The surgeries should be performed in stages and muscle-sparing procedures should be used to ensure a successful outcome.

Conflicts of Interest: The authors report no conflicts of interest.

Acknowledgement: We would like to thank the Director General of Health Malaysia for his permission to publish this article

Keywords: four-muscle surgery, large angle sensory esotropia, anterior segment ischaemia, strabismus.

four-muscle surgery, large angle sensory esotropia, anterior segment ischaemia, strabismus.