Y-Split Recession of the Medial Rectus Muscle as a Secondary and/or Unilateral Procedure in the Treatment of Esotropia with Distance/Near Disparity

Introduction. in esotropia with larger angles > near than at distance,splitting of the medial rectus muscle has been suggested as a treatment option. previous reports of bilateral medial rectus y-splitting as a first intervention showed a reduction of the distance/near disparity with fewer side effects compared to posterior fixation surgery. we address whether a medial rectus y-splitting as a secondary and/or a unilateral procedure also reduce distance/near disparity. materials and methods. we retrospectively reviewed the charts of four patients undergoing y-split recession as a second and/or unilateral surgery. main outcomes were distance/near disparity and squint angles. results and discussion. three of the four patients had undergone unilateral y-splitting of the medial rectus as a secondary surgery,three as a unilateral procedure. mean distance/near disparity was reduced from 17 pd preoperatively to zero at the final follow-up (fu). preoperative angles ranged from 45 pd to 66 pd at near and from 25 pd to 55 pd at distance. at the final fu,these angles ranged from 0 pd to 20 pd at near and at distance. mean fu was 42 months (range: 12-60 months). conclusion. y-split recession as a secondary and/or unilateral surgery for distance/near esotropia can reduce distance/near disparity with good long-term results. residual esotropia can be corrected by adding resection of the lateral rectus muscle. © 2017 monika wipf et al.