Bilateral Medial Rectus Muscle Recession: Results in Children With Developmental Delay Compared With Normally Developed Children

Purpose: We sought to compare bimedial rectus muscle recession (BMR) results for esotropia in children with developmental delay with the results in normal children. Methods: A retrospective analysis of all the children that underwent standard BMR surgery for esotropia during a 10 year period was undertaken. The surgical results of children with developmental delay were compared with those of normal children. Results: In the developmentally delayed group, the mean angle of esotropia before surgery was 53 ± 12 PD, the mean amount of medial rectus recession was 5.4 ± 0.56 mm, 0.84 mm less than the standard amount of recession, and at the last follow-up visit only 56% achieved surgical success (within 10 PD of orthophoria). Among the failures, 86% were undercorrected, only one patient developed consecutive exotropia after surgery. In the developmentally intact group, the mean angle of esotropia before surgery was 37.4 ± 8 PD, the mean amount of medial rectus recession was 5.2 ± 0.65 mm, and 94% achieved surgical success. Among surgical failures, we observed only a single case of overcorrection. Conclusion: A higher rate of surgical failure was found in developmentally delayed children who received a smaller recession amount of the medial rectus muscles when compared with the developmentally normal children who received a standard amount of recession. The main reason for surgical failure in the developmentally delayed group, in a follow-up period of 2 years, was undercorrection of the angle of esotropia. It seems that decreasing the surgical table by a certain amount in children with developmental delay may lead to undercorrection. Therefore, we need to delineate the ideal amount of surgery in this unique group of individuals.