Background: Surgery for infantile large angle esotropia is not uniform. Bilateral medial rectus recession (BMR), combined recess-resect procedure, also combined with simultaneous contralateral medial rectus recession or secondary other procedures are common. Alternatively, bilateral medial rectus recession with posterior fixation suture (BMRF) has been used. We analysed the effect of BMRF for this specific indication.

Patients and Methods: We undertook a retrospective evaluation of squint angles in simultaneous (S) and alternating (A) prism cover test before and 3 months after BMRF with and without additional oblique muscle surgery as primary surgery for esotropia >= 20 degrees performed at our department between 1997 and 2009, as well as the rate of second procedures.

Results: Sixty-one children (0.5% of all patients who received eye muscle surgery during the same time interval) were included. Medians (10% and 90% quantiles) were: age at surgery 48.4 months (23.6; 76.0), refraction (spherical equivalent) 2.25 dpt (0.25; 5.50), posterior fixation 5.5 mm + 13.0 mm (12.5; 13.0) from limbus, recession 5.0 mm (4.0; 5.0), inferior oblique recession in 29 children (27 bilateral), preoperative squint angles at 5 m S/A 29 degrees (20; 40), at 0.3 m S/A 35 degrees (24: 45), postoperative at 5 m S0 degrees (-6; 10), A 2 degrees (-6; 11), at 0.3 m S1 degrees (-5; 12), A 3.5 degrees (-5; 13), S <= 5 degrees in 70.2% at 5 m and 60.3% at 0.3 m, consecutive exotropia 6-10 degrees and > 10 degrees in 7.0 and 3.5% at 5 m and 8.6 and 1.7% at 0.3m, residual esotropia 6-10 degrees and > 10 degrees in 10.5 and 8.8% at 5 m and 13.8 and 15.5% at 0.3 m. Seven children (11.5%) were re-operated for esotropia, four for exotropia (6.6%).

Conclusion: Bilateral medial rectus recession with retroequatorial myopexy (Clippers procedure) is an effective one-step procedure for large infantile esotropia. In roughly two-thirds of the cases, the squint angle was corrected within +/- 5 degrees with one surgery, which is similar to reported success rates of BMR.