Stability and effects of muscle transplantation for very large angle esotropia: A study of 22 patients

PURPOSE: A very large angle esotropia is characterized by an angle more than 80 prism diopters (pd). A single eye surgery would not correct such a large angle. Supramaximal recessions and resection would lead to restriction of ocular motility. We present a series of 22 patients with large angle esotropia treated with muscle transplantation. METHODS: A total of 22 patients (14 males and 8 females) were included in the study. All the patients had a minimum of 80 base out deviation in primary position. All patients underwent thorough preoperative orthoptic checkup and refraction. The patients were followed up on day 1, day 30, at 6 months, at 1 year, and 2 years. All the patients underwent standard muscle transplantation, where the resected extra stump of lateral rectus was transplanted to the medial rectus using 6-0 prolene which was recessed by a standard recession technique. RESULTS: The mean age of the 22 patients was 32.21 ± 13.1 years. The mean preoperative angle was 92.4 ± 13.5 pd base out. The mean postoperative angle at 2-year follow-up was 12.3 ± 9.9 pd. The average correction achieved per mm was 4.1 ± 0.3 pd. The adduction restriction was <1 in all the patients at the end of 2 years except one patient. The abduction was normal in all the patients. CONCLUSION: The true muscle transplantation is a safe alternate option for large angle esotropia when uniocular surgery is desired. The surgical results are stable in long-term and therefore a viable option.