Variability in response to bilateral medial rectus recessions in infantile esotropia

Purpose: To evaluate factors associated with surgical success in bilateral medial rectus recessions in infantile esotropia. Methods: The results of 97 patients with infantile esotropia undergoing surgical correction from January 2010 through December 2013 at Children's Medical Center of Dallas were reviewed. Multivariate logistic regression analysis of risk factors for success and evaluation of the relationship of surgical responses to baseline characteristics were performed. Results: The authors achieved an overall success rate of 59% (57 of 97 patients) with one surgery. At the time of surgery, preoperative angle, refraction, amblyopia, and simultaneous inferior oblique surgery were not significantly related to success or failure. The mean dose response was 3.61 ± 1.45 prism diopters per millimeter of surgery and was modestly correlated only with the preoperative deviation (r2 = 0.32). Failure was associated with variability in dose-response, not inadequate or inconsistent with surgical dosing. Conclusions: Surgical success with bilateral medial rectus recessions in infantile esotropia is limited by the high variability in surgical dose-response.