A comparative study of medial rectus slanting recession versus recession with downward transposition for correction of V-pattern esotropia.

PURPOSE: To compare the effect of medial rectus slanting recession versus medial rectus recession with downward transposition for correction of V-pattern esotropia without significant oblique muscle dysfunction.

METHODS: A total of 18 patients having V-pattern esotropia, without significant oblique muscle dysfunction were included in this randomized, prospective study. These were divided equally into 2 groups. The SLANT group underwent bilateral medial rectus muscle slanting recession: the lower pole of the medial rectus muscle was recessed a larger amount than the upper pole on the basis of the angles of esotropia in upgaze and downgaze, respectively. The TRANS group underwent bilateral medial rectus recession according to the angle of esotropia in the primary position, with half-tendon width downward transposition. Patients were followed for at least 6 months.

RESULTS: Postoperatively, esotropia in the primary position was corrected to within 10Delta of orthotropia in 8 of 9 patients in the SLANT group and 7 of 9 patients in the TRANS group. All uncorrected patients showed a residual esotropia. All studied patients showed collapse of V-pattern esotropia to less than 10Delta difference between upgaze and downgaze. The mean V-pattern collapse was from 31.1Delta to 5.33Delta (25.8Delta) in the SLANT group and from 27.8Delta to 5.6Delta (22.2Delta) in the TRANS group. The difference between both groups was insignificant (p = 0.17). Both techniques significantly collapsed the esodeviation and V pattern (p < 0.05).

CONCLUSIONS: Both slanting medial rectus recession and medial rectus recession with downward transposition corrected V-pattern esotropia, with no clinically or statistically significant differences in success rate.