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Scar tissue removal can correct esotropia after pterygium excision surgery
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Surgical removal of scar tissue either with or without medial rectus muscle recession can realign vision in patients who develop incomitant esotropia after undergoing pterygium excision, a small study found.
Noa Ela-Dalman, MD, and colleagues at the Jules Stein Eye Institute, Los Angeles, reviewed outcomes of corrective surgery in six patients who developed incomitant esotropia, limited abduction and diplopia an average of 40 days after pterygium excision surgery. The patients averaged 39 years of age, and five of the six patients chose to undergo surgery to correct their diplopia.
Preoperatively, the angle of deviation averaged 6 prism diopters (PD) in the primary position, 13.8 PD in the abducting field of gaze of the affected eye and 5 PD in the adducting field of gaze of the affected eye. Also, the near angle of deviation ranged from 6 PD of exophoria to 20 PD of intermittent esotropia, according to the study.
In all surgically treated patients, surgeons excised scar tissue between the limbus and the plica semilunaris to release restriction. Three patients also required recession of the ipsilateral medial rectus muscle, and one patient was treated with 0.3% mitomycin-C to prevent reformation of scar tissue, according to the study.
The one MMC-treated patient had the most severe scarring, which resulted from three previous pterygium surgeries, the authors noted.
At 5 months mean follow-up, all patients were orthotropic in the primary position and adducting field of gaze. Esotropia in the abducting field of gaze decreased to 5 PD, and no patients had diplopia at last follow-up, the authors said.
The study is published in the March issue of Archives of Ophthalmology.