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Lateral rectus resection versus medial rectus re-recession for residual esotropia: early results of a randomized clinical trial


Professor Zhale Rajavi, No. 31, Rafat Avenue, Shariati Street Tehran, Iran. Email:


Purpose:  To compare lateral rectus muscle resection with medial rectus muscle re-recession for patients with residual esotropia.

Methods:  This randomized controlled clinical trial included 25 patients (mean age, 18.8 ± 8.7 years) with residual esotropia who were candidates for reoperation. They were randomly assigned into two groups: re-recession group (n = 12), in which the medial rectus muscle was recessed again, and the resection group (n = 13), in which lateral rectus muscle resection was performed. Postoperative deviation ≤10 prism dioptres was considered to be treatment success.

Results:  The success rate of the re-recession group and the resection group was 67% and 54%, respectively; this difference was not statistically significant. Each 1 mm of medial rectus re-recession and lateral rectus resection corrected 7.5 ± 1.2 and 2.5 ± 0.5 prism dioptres of residual esotropia, respectively. In 50% of the re-recession group, mild medial rectus muscle underaction occurred; however, only 16.5% developed an increase in the near point of convergence. Major intraoperative and postoperative complications, including overcorrection and slippage or a lost muscle, did not occur in any of the patients.

Conclusions:  Medial rectus muscle re-recession can be a substitute for lateral rectus muscle resection in patients with residual esotropia. The resultant underaction of the medial rectus muscle after re-recession is relatively mild and causes no major problems.