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The following is a summary of “Common Forms of Adult Esotropia Require Augmented Surgical Dosing,” published in the February 2025 issue of American Journal of Ophthalmology by Yehezkeli and Demer. 

Age-related distance esotropia (ARDE) in older adults (OAs) was primarily caused by sagging eye syndrome, while decompensated esophoria (DE) led to progressive esotropia in younger adults. 

Researchers conducted a retrospective study to examine claims that medial rectus (MR) recession dosing needed to exceed customary recommendations to prevent surgical undercorrections in treating DE and ARDE. 

They analyzed strabismus surgery dosing by comparing actual MR recession measurements with Parks’ tables in individuals with DE and ARDE from 2015 to 2024. The Institutional Review Board at the University of California, Los Angeles, approved the study. Records of individuals diagnosed with purely horizontal strabismus due to DE and ARDE were reviewed. Gender was self-identified. All underwent bilateral MR recession using a standard technique by the same surgeon at Stein Eye Institute, University of California, Los Angeles. Exclusion criteria included prior strabismus surgery, significant ocular pathology, amblyopia, ocular or head trauma, neurological conditions affecting eye movements, follow-up under 1 week, or concurrent strabismus such as hypertropia. 

The results showed that strabismus surgery was performed in 54 individuals with DE with a mean age of 31±12 years (standard deviation) and 61 individuals with ARDE with a mean age of 70±8 years. Preoperative esotropia was significantly higher in DE at 21±10Δ than in ARDE at 14±9Δ (P =0.0003). Surgery initially achieved orthotropia in most cases, but esotropia recurred in 10 individuals with DE (22%) after a mean of 3±1.3 years due to a greater decline in surgical effect than in ARDE (P =0.0022). No correlation was found between the use of adjustable sutures and reoperation (P =0.73). Regression analysis showed that initial MR recession of 4.6 mm in DE and 3.5 mm in ARDE had no impact on final alignment, but each additional mm of total MR recession corrected 3Δ in DE and 2.4Δ in ARDE. These corrections were less than predicted by Parks’ tables. 

Investigators concluded that while current augmented MR recession recommendations for ARDE are generally suitable, dosage should be further increased in DE to prevent under correction due to early esotropia recurrence. 

Source: ajo.com/article/S0002-9394(25)00057-1/fulltext