Surgical Outcomes of Medial Rectus Recession in Esotropia with Cerebral Palsy

Purpose: To determine the outcome of a reduced amount of medial rectus (MR) muscle recession in esotropes with cerebral palsy (CP) and to compare the surgical response with that of normal controls. Design: Retrospective cohort study. Participants: Thirty esotropes with CP and 60 age-matched esotropes without CP who underwent a unilateral or bilateral MR muscle recession. Methods: The surgical amount of MR muscle recession was reduced by 1 mm per muscle in patients with CP. Main Outcome Measures: Success rates, surgical response, cumulative probabilities of success, and factors affecting surgical responses evaluated by generalized linear mixed models. Results: In patients with CP, the initial success rate was higher (P = 0.037) and the rate of undercorrection was lower (P = 0.037) compared with patients without CP. At the final visit, success rates were not significantly different between both groups. However, the rate of overcorrection was higher (P = 0.003) compared with patients without CP. The rate of overcorrection per person-year during follow-up was 11% in patients with CP and 2% in patients without CP. Patients with CP showed a greater surgical response than did those without CP, at about 1.3 prism diopters per millimeter of MR muscle recession (P<0.001). Conclusions: Even with the reduced amount of recession, esotropes with CP showed a greater surgical response to MR muscle recession than did those without CP, and the incidence of late overcorrection was significantly higher compared with that of patients without CP. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.