Impact of Adding Augmented Superior Rectus Transpositions to Medial Rectus Muscle Recessions When Treating Esotropic Moebius Syndrome

Citation:

Warkad VU, Hunter DG, Dagi AF, MacKinnon S, Kazlas MA, Heidary G, Staffa SJ, Dagi LR. Impact of Adding Augmented Superior Rectus Transpositions to Medial Rectus Muscle Recessions When Treating Esotropic Moebius Syndrome. Am J Ophthalmol 2021;

Date Published:

2021 Nov 12

Abstract:

PURPOSE: Describe outcomes after treatment of Moebius syndrome (MBS) esotropia by adjustable bilateral medial rectus recession (BMR) with and without augmented superior rectus transposition (SRT) DESIGN: Retrospective case series METHODS: Patients meeting 2014 diagnostic criteria for MBS and treated at Boston Children's Hospital between 2003 and 2019 were identified via billing records and chart review. Visual acuity, sensorimotor evaluations, strabismus procedures, and other clinical features were recorded. Surgical outcomes for patients treated with strabismus surgery (excluding those with prior surgery elsewhere) were evaluated. Primary outcome measure was post-operative alignment comparing treatment by adjustable BMR versus adjustable BMR+SRT. RESULTS: Twenty patients had MBS, 12/20 (60%) were male. Fifteen (75%) had primary position esotropia, and all had bilateral abduction deficit. Eight of 20 met inclusion criteria for primary strabismus surgery outcome. Five had undergone adjustable BMR ranging from 4.5-6.5 mm. Three had undergone adjustable BMR+SRT, all with 4 mm medial rectus muscle recessions. Mean pre-operative esotropia before treatment by BMR was 39.5 PD (+/- 15 PD) with mean post-operative esotropia 9 PD (+/- 7.9 PD) at six months. Mean pre-operative esotropia before treatment by BMR+SRT was 70.8 PD (+/- 5.9 PD) with mean post-operative esotropia 2.5 PD (+/- 3.5 PD) at six months. Significantly greater reduction in esotropia resulted from BMR+SRT than BMR (P=0.036). CONCLUSIONS: BMR proved sufficient to treat esotropia < 50 PD and BMR+SRT for greater esotropia in patients with MBS-associated abduction limitation.

Last updated on 12/02/2021