Decrease of over-elevation in adduction after surgery of medial rectus muscles in partially refractive accommodative esotropia

Significance: The course of over-elevation in adduction after strabismus surgery has been evaluated in a small number of research in the literature, we believe our study is the first to report the results in a specific group of esotropia (ET) patients. Aim: To report the course of postoperative over-elevation in adduction in patients who underwent surgery for horizontal deviation on the medial recti in partially accommodative ET. Methods: The medical charts of patients who had partially accommodative ET with over-elevation in adduction were reviewed retrospectively. A scale from -4 to +4 was used to grade the oblique muscle function. Among these, 17 patients who were operated solely on the horizontal rectus muscles were identified. The primary outcome measure was the degree of improvement in over-elevation in adduction after medial rectus surgery. Results: Nine (52.9%) of the 17 patients (mean age: 5.18 +/- 2.24 months) were males and 8 (47.1%) were females. The mean follow-up period was 17.06 +/- 15.32 months. Overall, 15 patients (88.2%) achieved surgical success. The mean inferior oblique overaction was found 1.44 +/- 0.56 preoperatively and the final postoperative mean inferior oblique overaction was 0.53 +/- 0.51 (P = 0.001). Postoperative over-elevation in adduction after 3 months was significantly decreased compared to the preoperative value (P = 0.003, P = 0.001, P = 0.001 at 3(rd) and 6(th) months and final visits respectively). Conclusion: Over-elevation in adduction accompanying partially refractive accommodative ET seems to regress after medial rectus weakening surgery. This finding should be considered in the presurgical evaluation of these patients.