Lateral rectus resections in divergence palsy: Results of long-term follow-up

Introduction: Lateral rectus resections have been previously advocated as surgical options to treat patients with divergence palsy who do not respond well to prisms. This study was undertaken to review the results and long-term follow-up of patients with divergence palsy who underwent lateral rectus resections at our institution. Methods: Retrospective review of 29 patients (age 35-83 years) with divergence palsy. Five subjects underwent unilateral lateral rectus resection between 4.5 and 5.5 mm on adjustable suture and 24 subjects underwent bilateral lateral rectus resection between 3 and 7 mm on adjustable sutures. Results: Preoperatively, all patients had diplopia at distance and an esodeviation, which was greater at distance (mean 14.7 ± 5.1Δ) than at near (mean 4.7 ± 3.5Δ). Twenty-five subjects had previously been treated with prisms. Postoperative follow-up period ranged from 6 to 96 months (mean 38.7 ± 27.3 months). The angle of deviation at distance was significantly reduced to −0.1 ± 3.2Δ postoperatively (P < 0.0001). The angle of deviation at near reduced significantly to −2.2 ± 3.3Δ postoperatively (P < 0.0001). No patient was overcorrected for near. Two patients experienced recurrent postoperative diplopia at distance subsequently at 1 and 4 years, which was corrected with prism glasses and lateral rectus re-resection. Conclusion: Lateral rectus resection in patients with divergence palsy is an effective and stable procedure in patients with divergence palsy over long-term follow-up periods, with minimal risk of overcorrections at near.