Effectiveness of lateral rectus resection for residual esotropia in dysthyroid ophthalmopathy

PURPOSE: To report one surgeon's experiences with bilateral lateral rectus resections in dysthyroid ophthalmopathy patients with residual esotropia after initial bilateral medial rectus recession. DESIGN: Retrospective interventional case series evaluating outcomes. METHODS: Medical records for patients with dysthyroid ophthalmopathy who underwent bilateral lateral rectus resections for persistent esotropia by a single surgeon from June 2012 to June 2015 were retrospectively reviewed. All patients had residual esodeviations following initial bilateral medial rectus recession. The goal of surgery was to obtain fusion in primary gaze and the reading position without prism, with a postoperative deviation equal to or less than 8 at distance and a phoria at near without diplopia. RESULTS: Seven of the 9 patients were successful in achieving this goal. Preoperative esotropia before resection ranged from 12(Delta) to 30(Delta) (23.1(Delta) +/- 10.3(Delta)) at distance and -2(Delta) to 40(Delta) (14.9(Delta) +/- 12.3(Delta)) at near. No exodeviation was created at near by the resections, but 1 patient had an asymptomatic exophoria both pre- and postoperatively. CONCLUSION: Patients with large horizontal misalignment may have residual esodeviations that are too large for correction with recession alone. Given our findings, we believe resection may be an effective tool in resolving esotropia in certain patients with restrictive strabismus. (C) 2016 Elsevier Inc. All rights reserved.