Medial rectus muscle elongation, a technique to treat very large-angle esotropia

Bilateral medial rectus recession with or without posterior fixation in large-angle infantile esotropia: a randomized controlled trial

PURPOSE

To compare the results of bilateral medial rectus recession (BMRc) versus bilateral medial rectus recession with Faden operation (BMRF) in the treatment of large-angle infantile esotropia.

STUDY DESIGN

A double blinded, parallel, randomized controlled trial.

METHODS

Patients with large-angle infantile esotropia (≥ 60 prism diopters, [PD]) aged between 3 and 15 years old were included and assigned to either the BMRc or BMRF group. Mean difference and mean reduction of angle deviation between the two groups were compared at 1 week, 1, 3, and 6 months by using generalized estimating equations analysis. Surgical success rates, defined as an esodeviation ≤ 10 PD at near fixation, were evaluated at 6 months postoperatively. Complications from the surgical procedures were observed.

RESULTS

Of 40 enrolled patients, the mean (SD) age of the patients in the BMRc group was 3.4 (1.9), and in the BMRF group, 5.2 (3.8) years old. The overall mean differences of angle reduction between both groups were not significant (-6 PD, 95%CI -14 to 2, P = .12). The surgical success rate at 6 months in the BMRF group (72%) was not different compared to BMRc group (84%, P = .45). Overall consecutive exotropia was 5%, not different between groups (P > .99). There was no difference of complications between the two groups (P = .51).

CONCLUSION

BMRF and BMRc approaches show no difference in treatment of large-angle infantile esotropia. Nevertheless, a long-term assessment for consecutive exotropia should be considered for both surgical procedures.

Yokoyama procedure for a woman with heavy eye syndrome who underwent multiple recession-resection operations: A case report

BACKGROUND

Heavy eye syndrome (HES) is an acquired strabismus typically seen in eyes with high myopia. We report a classic case in which a patient was misdiagnosed with esotropia and underwent disinsertion of the medial rectus muscle and lateral rectus muscle resection procedures.

CASE SUMMARY

A 71-year-old woman presented with both eyes fixed in adduction and infraduction for 33 years. She had undergone three complicated strabismus surgeries to amputate the left medial rectus (MR) muscle with lateral rectus muscle recession, but no improvement in the esotropia appeared after each operation. She was diagnosed with HES and underwent a bilateral Yokoyama procedure and recession of the right MR muscle under general anesthesia. After surgery, her eyes were binocularly aligned for 6 mo. This case suggests that pertinacious esotropia combined with high myopia must be considered in HES. Orbital imaging and ultrasonography can demonstrate anatomical abnormality and muscle paths to confirm a definite diagnosis.

CONCLUSION

The Yokoyama procedure was effective in correcting HES.

Supramaximal Recession and Resection Surgery in Large-Angle Strabismus: Outcomes of Large Interventional Case Series Exotropia and Esotropia

Purpose:

To assess the postoperative surgical outcomes and the changes in deviation in patients treated by supramaximal recession and resection (R&R) of rectus muscles to correct the large-angle exotropia and esotropia.

Methods:

This study was a prospective interventional case series, and patients with esotropia of ≥65 prism diopter (PD) or exotropia of ≥60 PD who had undergone supermaximal R&R in non-fixating eye with lower vision in unilateral strabismus or bilateral medial rectus (BMR) recession up to 8.5 mm for esotropia and bilateral lateral rectus (BLR) recession up to 12.5 mm for exotropia in bilateral strabismus were enrolled. Successful results were achieved if postoperation deviation was <10 PD for esotropia and <15 PD for exotropia during their final examinations.

Results:

A total of 131 cases (48 patients with esotropia and 83 patients with exotropia) were included. The mean ages of the patients with esotropia and exotropia were 16.83 ± 15.06 and 23.19 ± 11.29 years, respectively. The mean preoperative esodeviations for bilateral and unilateral surgeries were 69.5 ± 6.5 and 80.7 ± 10.3, respectively, and these values for bilateral and unilateral exodeviations surgeries were 67.3 ± 7.6 and 74.2 ± 12.1, respectively. The overall successful outcomes were achieved in 50% of the esotropic patients and 79.5% of the exotropic patients. At final follow-up examination, no patient had diplopia on lateral gazes.

Conclusion:

Based on our surgical results, it is possible to consider monocular recession-resection surgery in non-fixating eye (with poor vision) or BLR and BMR recession in both eyes as a viable option for surgical treatment of large angles deviations.

Innovative techniques for the treatment of adult strabismus

Adult strabismus is often characterized by surgical complexity. In recent years, several innovative techniques for the management of complex strabismus have been developed. Strabismus surgeons should understand the indications for various strabismus surgical techniques in the management of these difficult cases. This workshop describes several new surgical techniques to manage complex strabismus, including small-angle incomitant and very large-angle strabismus, torsional diplopia, and restrictive, paralytic, and secondary strabismus. Because strabismus surgery is an ever-evolving field, it is important to continue to refine our surgical armamentarium. Strabismus surgeons may wish to add these techniques to their surgical repertoire for select cases.

Bimedial rectus muscle elongation versus bimedial rectus muscle recession for the surgical treatment of large-angle infantile esotropia

PURPOSE

To compare bimedial rectus muscle recession (BMRR; 7-8 mm) and bimedial rectus muscle elongation (BMRE; 6.5-9 mm) for the surgical treatment of large-angle infantile esotropia (ET; ≥70 prism diopters [PD]).

PATIENTS AND METHODS

Twenty-four patients with large-angle infantile ET were divided into 2 groups; group A (n=12) underwent BMRR and group B (n=12) underwent BMRE. All patients received surgery under general anesthesia and were followed for at least 24 months after surgery. The mean dose-response effect at 24 months was calculated for each patient.

RESULTS

The mean preoperative angle of deviation was 79.16±7.64 PD (range, 70-90) in group A and 85.83±9.25 PD (range, 70-100) in group B. The duration of surgery was 55% shorter in group A compared with group B. There were no cases of over-correction, but there were 6 cases of under-correction in group A (50%) and 2 cases of under-correction in group B (16.7%). The mean dose-response effect was 4.42±0.19 PD/mm in group A and 5.45±0.39 PD/mm in group B.

CONCLUSION

BMRE is more effective than BMRR for the surgical treatment of large-angle infantile ET despite a higher level of technical difficulty.