Comparison of bilateral medial rectus recession vs recession-resection as surgery for infantile esotropia (original) (raw)
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Factors influencing sensory outcome following surgical correction of infantile esotropia
The American orthoptic journal, 2002
The aims of this study are to compare the binocular function following 7mm vs. standard (3.5 to 6.5mm) bilateral medial rectus recessions, and to determine whether timing of surgery or duration of misalignment prior to surgery impact on binocular function. Methods : Participants were 85 children with infantile esotropia: all had deviations of 50(Δ) or more and were followed for a minimum of four years. At a mean age of 7 years binocular function was assessed with the Randot(©)©Preschool stereo test, the Titmus(©) fly, and the Worth 4 dot test. Results : There were 37 children in the 7mm recession group and 48 in the standard recession group. There was no difference in binocular sensory outcome for either stereopsis (P = 0.3) or fusion between the two types of surgery. For all children the duration of misalignment prior to initial surgery (P < 0.01) and age at alignment (P = 0.04) were associated with stereopsis. Duration of alignment following first surgery, however, was not asso...
Outcomes of Surgery in Long-Standing Infantile Esotropia With Cross Fixation
Background: This is a retrospective study to determine the outcomes of the surgical correction in long-standing infantile esotropia with cross fixation. Methods: Medical charts of a group of patients with esotropia who had cross fixation and underwent surgery for strabismus between January 1991 and December 2004 were reviewed. The mean follow-up time was 4.7 years. Binocularity was measured by the Worth 4-dot test and Titmus stereo test. Twenty-six patients underwent surgery for strabismus. Twenty-one patients aged 8 to 26 years with a minimum 3-year postoperative follow-up were included. Five patients were excluded because they were lost to follow-up after surgery. Results: Bimedial recession and resection of one lateral rectus muscle were performed in all patients. Recession of the inferior oblique muscle with anteriorization was performed in patients who had inferior oblique overaction. Orthotropia was attained in 14 patients, whereas residual esotropia was diagnosed in 5 patients. Two patients were diagnosed as having exotropia. Two patients required a second surgery for dissociated vertical deviation. Overall, 9 of the 21 patients had indications of binocular function and 12 remained the same in their stereoacuity. Conclusion: Surgical correction of long-standing infantile esotropia with cross fixation in young adults may improve binocular function and allow long-term alignment stability. [J Pediatr Ophthalmol Strabismus 2011;48:77-83.]
Clinical Ophthalmology, 2014
Aim: This prospective study compares the results of bilateral medial rectus recession versus (vs) Y-split recession of medial recti techniques for surgical management of essential infantile esotropia. Patients and methods: Thirty patients were included in this study and had preoperative infantile esotropia with large angles (ie, 30 prism diopters [PD]). Patients were divided into Group A, which underwent bilateral medial rectus (BMR) recession and Group B, which underwent bilateral Y-split recession of medial recti muscles. All patients were subjected to complete ophthalmologic examination and met the criteria for inclusion in this study. The degrees of BMR recessions performed ranged from 6.0-7.5 mm. All operations were performed under general anesthesia. Follow-up visits were conducted at 1 and 2 weeks, and 1, 3, and 6 months postoperatively. Rates of reoperation for residual esotropia and consecutive exotropia were determined. Results: The patients' preoperative angles of deviation ranged from 30-80 PD. Group A consumed 57% less operative time than Group B. Immediately postoperatively, the Y-splitting technique showed satisfactory results (ie, orthotropic or residual angles 15 PD) in 73% of patients vs 67% only for the BMR recession patients. By the end of six months of follow up; 13% of the BMR technique patients vs 27% of the Y-splitting technique patients showed negative change of PD but without reoperation. Conclusion: Our results suggest that, although the Y-splitting technique is more difficult and time consuming, both procedures are effective and have shown comparable results for the correction of horizontal deviation 70 PD.
Journal of ophthalmology, 2018
This study compares the results of Y-split recession versus de Decker's (modified Cüppers) Faden techniques of medial rectus (MR) muscles for the management of essential infantile esotropia (IET). Fifty patients had IET divided into Group A who underwent Y-split recession of MR muscles and Group B who underwent de Decker's Faden technique of MR muscles. All patients had complete ophthalmic examination done including deviation angle measurement and met the inclusion criteria of the study. Operations were performed using general anesthesia. Patients were followed up at day 1, week 1, and months 1, 3, and 6 after operation. The mean age distribution for group A was 21.56 months (SD 12.55) and for group B was 21.4 months (SD 12.35), and the mean postoperative follow-up interval was 6 months for both groups. The preoperative maximum angle of deviation in both groups ranged from 15 to 40 degrees, while the minimum angle of deviation ranged from 10 to 20 degrees. Immediately postop...
Results of early alignment of congenital esotropia
Ophthalmology, 1999
To determine the long-term motor and sensory results after early surgical correction of patients with congenital esotropia. Noncomparative interventional case series. Ten infants with congenital esotropia. Patients had bimedial rectus recession between 83 and 159 days of age; were re-examined in a regular follow-up program; and were retreated when required for strabismus, amblyopia, and refractive errors. Final alignment, stereo acuity, variations in vision, alignment, refraction, and number and types of retreatments required during the period of observation. All patients were aligned initially with bimedial rectus recession of 8.0 to 10.0 mm measured from the limbus. A total of 11 additional surgical procedures were performed on 7 patients to maintain alignment. Four patients required hyperopic spectacle correction to maintain alignment, and two patients required short periods of patching. Visual acuity was 20/40 or better in 19 eyes at the most recent examination, which was betwee...
The Outcome of Bilateral Medial Rectus Muscle Recession in Esotropia
Iranian Journal of Ophthalmology, 2014
Purpose: To identify the postoperative surgical outcomes and the changes in deviation in patients treated by bilateral medial rectus (BMR) recession for small to large angle esotropia with a minimum follow-up of two years Methods: In this retrospective and consecutive case series, we reviewed medical records of 130 patients who had recession surgery for correction of esotropia between 2001-2011 in a tertiary center in Tehran. Patients were excluded if neurological abnormalities or developmental delays were documented and if structural eye abnormalities were present. Results: One month after operation (n=109), there were 85 successful cases (orthophoria or deviation less than 10 prism diopter), 18 cases of undercorrection, and six cases of overcorrection. The success rate at two years after surgery (n=82) was 78.2% with 13.3.% undercorrection and 8.5% over correction. The preoperative angle of esodeviation and patients’ age are found to significantly influence the response to the sur...
Pre-operative stability of infantile esotropia and post-operative outcome
American Journal of Ophthalmology, 2004
PURPOSE: To define the prevalence and time course of significant changes in angle of deviation during the first months after the diagnosis of infantile esotropia and to determine whether long-term alignment and sensory outcomes differ when surgical alignment is performed on infants with stable vs unstable angles of deviation.
Introduction: Accomodative esotropia is secondary to inappropriate convergence during accomodative effort in an uncorrected hyperope and is often familial. Case presentation: we report the case of 20 year old Caucasian patient with congenital esotropia alternating, of 30 prism diopters distance (5 m) and 40 prism diopters of esotropia at near, in both eyes. Measures: Was performed strabismus, in peribulbar anesthesia, the right medial rectus was cashed 3.0mm, the left medial rectus was collected 3.5 mm. Results: Immediately after surgery, the patient complained of intermittent diplopia, resolved with orthotic exercise which stimulated binocular vision, Conclusion: This case report suggests that the surgical correction strabismus, should be considered with due caution in the treatment of congenital esotropia alternating and branches, and in some clinical scenarios selected to avoid the complication of postoperative diplopia, that in the case report resolved so benign. After three months surgical treatmen, remains a small angle strabismus aesthetically acceptable, has not given double vision and remains abnormal retinal correspondence with orthotic exercise.
Outcome of early surgery in infantile esotropia: Our experience in tertiary care hospital
Medical Journal Armed Forces India, 2017
Background: Infantile esotropia is a convergent strabismus presenting before 6 months of age and is the most common strabismus disorder presenting in the ophthalmology OPD. The dilemma of whether to go for early surgery and how early has been a matter of research for the last 50 years. We describe our results of surgery in infantile esotropia at variable age groups, as well as with different reoperation rates and compare with the results in western literature. Methods: A prospective study was carried out through a review of 113 cases operated for infantile esotropia between February 2013 and August 2014. The variables studied were: age at surgery, type of fixation, refractive error, associated nystagmus, inferior oblique overaction or dissociated vertical deviation (DVD), type of surgery performed and pre-and postoperative deviation angles. Results: There were 67 male and 46 female cases of infantile esotropia. The age group of patients varied from 6 months to 12 years. Latent nystagmus was seen in 22 cases, inferior oblique overaction in 49 cases and DVD (mild) in 14 cases. Bimedial rectus recession was done in 78 cases and recession-resection in non-dominant eye in remaining 35 cases. The postoperative residual deviation was <10 PD in 102 cases, between 10 and 16 PD in 5 cases and more than 16 PD in 6 cases. Only 6 cases (5.3%) required reoperation for correction of residual deviation. Conclusion: The authors recommend surgery before 12 months in all cases of infantile esotropia. The reoperation rates in the current study were considerably low.