Inferior rectus recession—an eVective procedure?

Aims—To examine the postoperative stability of inferior rectus recession, with particular reference to the incidence of progressive overcorrection. Methods—The results of consecutive patients undergoing inferior rectus recession over a 3 year period were reviewed. Results—21 patients underwent inferior rectus recession, using an adjustable suture technique in all but three cases. In 16 patients additional vertical muscle surgery was performed at the time of the inferior rectus recession. All patients were followed for a minimum of 3 months postoperatively, with a mean follow up of 9.3 months. At the final postoperative visit 11 patients were well aligned, eight were undercorrected, and two were overcorrected. In five of the eight undercorrected cases, the residual deviation was the result of postoperative drift in the direction of the preoperative deviation, following an initially good alignment. Review of the results failed to reveal any factor predictive for this postoperative drift. Conclusion—The risk of postoperative overcorrection following inferior rectus recession should be considered, but in this study, undercorrection occurred more frequently than overcorrection. The possible reasons for overcorrection and undercorrection are discussed. (Br J Ophthalmol 1997;81:1031–1036) Recession of the inferior rectus muscle is an established treatment for vertical strabismus. The most common indications are contralateral inferior rectus recession in cases of superior oblique paresis, and ipsilateral inferior rectus recession in cases with limited elevation, secondary to thyroid orbitopathy. Progressive overcorrection following an initially good postoperative alignment has been reported in some patients undergoing inferior rectus recession. It is suggested that the risk of overcorrection is increased in cases of thyroid orbitopathy 5 and when an adjustable suture technique is used. 6–8 The results of inferior rectus recessions, carried out over a 3 year period in Southampton, were retrospectively reviewed in order to determine the eYcacy of the procedure, and the long term stability of the result. Patients and methods The notes of all the patients who had undergone inferior rectus recession by one surgeon (RJM), over the 3 year period from January 1991 to January 1994, were reviewed. Preoperatively, all patients had undergone a full orthoptic and ophthalmic assessment, and any appropriate additional investigations to establish the aetiology of the muscle imbalance. The deviation had been stable for a minimum of 6 months before surgery in all cases. Patients with a postoperative follow up of less then 3 months were excluded from the study. In all cases a standard inferior rectus recession was performed, with careful dissection of the fascial attachments and check ligaments as far posteriorly as possible, and at least to the level of the vortex veins. One mm of recession was performed for each 3 of vertical deviation. The surgical aim was orthotropia, or a vertical undercorrection of less than 4 in the primary position, immediately postoperatively. Owing to the incidence of overcorrection reported in cases of thyroid orbitopathy, 5 the aim in this group was an undercorrection of 4–6 immediately postoperatively. In cases with potential for binocular vision, the aim was to maximise the field of binocular single vision, particularly in the primary position and downgaze, without inducing symptom producing inferior rectus underaction. The procedure was performed using an adjustable suture technique in cooperative patients. Surgery to other extraocular muscles was undertaken at the same time as the inferior rectus recession, where indicated. Results Twenty one patients underwent inferior rectus recession. The age range was 7–82 years (mean 37 years). There were 11 males and 10 females. Postoperative follow up ranged from 3 to 27 months (mean 9.3 months) The preoperative diagnosis was unilateral superior oblique underaction in 13 cases, thyroid orbitopathy in two cases, and a vertical deviation following retinal detachment repair British Journal of Ophthalmology 1997;81:1031–1036 1031 Southampton Eye Unit S M Scotcher E A O’Flynn R J Morris Correspondence to: R J Morris, Southampton Eye Unit, Tremona Road, Southampton SO16 6YD. Accepted for publication 10 April 1997 group.bmj.com on September 21, 2017 Published by http://bjo.bmj.com/ Downloaded from