Bilateral medial rectus recession outcomes for acute acquired comitant esotropia vs infantile esotropia
Reviewed by Fiona Rowe

In this study, the aim was to describe the surgical dose response of bilateral medial rectus muscle recession (MRR) in acute acquired comitant esotropia (AACE), compared to infantile esotropia (IET). This was a retrospective study of 114 patients; 39 AACE and 75 IET. 5 were lost to follow-up. Successful motor outcome was achieved for 74% with AACE and 63% IET. 5% of IET needed reoperation within 1 year but none for AACE in that time period. Preoperative AACE deviation was a mean of 42 ±12PD at distance and 30 ±11PD at near. Preoperative IET deviation was a mean of 51 ±20PD at distance and 50 ±14PD at near. Mean follow-up was 14 months for AACE and 21 months for IET. Over this time, mean postoperative deviation drifts at distance and near were 0 and 2PD for AACE and 8 and 4PD for IET, respectively. Mean surgical dose was 11.3 ±2mm for AACE and 11.7 ±1.5mm for IET. At 1-week postoperative, mean angle for distance and near was 38 ±11PD and 35 ±12PD for AACE, and 42 ±16PD and 45 ±14PD for IET, respectively. Dose response for distance and near was 2.67 and 3.48PD/mm for AACE, and 3.91 and 4.64PD/mm for IET, respectively. Limitations of this study were its retrospective nature, incomplete data for some patients, less AACE numbers, prism adaptation was not done, and short follow-up period. Results indicate MRR had a smaller dose response for AACE vs IET cases. The authors suggest increasing surgical dose of MRR to achieve better successful outcomes. They propose prism adaptation testing might have uncovered more latent deviation which would inform surgical dose decisions.

Surgical dose-responses of bilateral medial rectus muscle recession in acute acquired comitant esotropia compared to infantile esotropia.
Honglertnapakul W, Lertduailap W, Meethongkam K, Pukrushpain P. 
STRABISMUS
2025;33(4):239–46.