Surgery for large-angle congenital esotropia. Two vs three and four horizontal muscles.

Large-angle congenital esotropia is usually managed surgically by either of two fundamentally different approaches: (1) the uniform approach, in which surgery is restricted to two extraocular muscles (bimedial recessions or monocular recession-resection), or (2) the selective approach, in which bimedial recessions are combined with resections of one or both lateral rectus muscles. We compared surgical results of the two types of surgery during a ten-year period for 107 patients, of whom 57 underwent bimedial recessions, two had monocular recession-resections, and 48 received three- or four-muscle surgery. The average follow-up time was 2.6 years. The percentage of good surgical results (orthophoria +/- 10 PD) in the selective group was 64.5%, compared with 37.3% in the uniform group. Only three of the 48 patients in the selective group required a second procedure, compared with 17 of 59 patients in the uniform group.