A comparative study of medial rectus slanting recession versus recession with downward transposition for correction of V-pattern esotropia

Newly developed abnormal head position and secondary esotropia after strabismus surgery for children with intermittent exotropia

PURPOSE

To review cases of newly developed AHP and secondary esotropia (ET) after surgical correction for IXT.

METHODS

Medical records of cases with newly developed AHP and secondary ET after surgical correction for IXT were retrospectively reviewed.

RESULTS

Fifteen cases were included and the mean pre-operative exodeviation was 31.7 ± 10.6 prism diopters (PD) (range: 16-50) at distance. They received bilateral lateral rectus (LR) recessions (13/15), unilateral LR recession and medial rectus (MR) resection (1/15) or bilateral LR recession plus unilateral MR resection (1/15). Fourteen patients developed chin-down AHP with secondary V-pattern ET and 1 presented chin-up AHP with secondary A-pattern ET. The mean esodeviation in primary gaze was 22.7 ± 10.0 PD (range: 3-40) at distance. Twelve cases underwent a second surgery for correction of AHP and secondary ET, and approximately half (5/11) of the recessed LR muscles explored showed a 3-5 mm downward displacement of the new attachment. Surgical management mainly included advancement of LR to the original insertion with a 3-5 mm upward transposition. The AHP dissipated and ocular alignment returned to normal in all of these cases. Three cases did not require further surgery, and their AHP and secondary ET were no longer present at 2-5 months after the first surgery.

CONCLUSION

A downward shift of the recessed LR in IXT may lead to secondary V-pattern ET and development of a chin-down AHP. Advancement of LR with an upward transposition serves as an effective procedure for the correction of this complication.

Pattern strabismus and torsion needs special surgical attention

Pattern strabismus is relatively common in strabismus practice. Although it is classically used to include A and V patterns, the term has been expanded to include additional vertically incomitant horizontal strabismus. This article reviews the clinical features, etiopathogenesis, and surgical options for the patients with pattern strabismus.

Slanted medial rectus recession is effective in the treatment of convergence excess esotropia

PURPOSE

To evaluate the surgical outcomes of slanted medial rectus recession in patients diagnosed as having convergence excess esotropia.

METHODS

Bilateral slanted recession of medial rectus muscles was performed in 16 patients with convergence excess esotropia. The lower margins of medial rectus muscles were recessed 1 to 2 mm more than the upper margins. Changes in near-distance disparity of the deviations were recorded.

RESULTS

The mean preoperative near-distance disparity of 20.3±6.5 prism diopters (PD) decreased to 4.37±5.6 PD postoperatively. The amount of collapse was significant (mean: 16 PD; P<.005). Near-distance disparity of 10 PD or less was obtained in 14 patients after surgery (87.5%), except 2 patients who had 16 PD of disparity. The authors did not encounter overcorrection except in 1 patient in whom minimal exophoria at distance and near with the glasses was observed and reduced the prescription.

CONCLUSIONS

Bilateral slanted medial rectus muscle recession procedure effectively decreases the disparity between near and distance deviations in patients with convergence excess esotropia.

Horizontal muscle transposition or oblique muscle weakening for the correction of V pattern?

PURPOSE

To report and to analyze the efficacy of horizontal rectus muscle transposition and inferior oblique muscle weakening in terms of pattern correction for patients with V pattern.

METHODS

The review of the medical files identified 55 patients who had esotropia (ET) or exotropia (XT) with V pattern. The primary outcome measure was the amount of V pattern collapse (Δ).

RESULTS

Of the 55 patients (mean age 22.1 ± 9.5 years), 27 (49.1%) were males and 28 (50.9%) were females. The type of deviations was XT in 30 patients (54.5%) and ET in 25 patients (45.5%). Inferior oblique muscle weakening was performed in 43 (78.2%) patients, whereas horizontal muscle transposition was carried out in 12 (21.8%) patients in addition to recession-resection procedures. The amount of pattern was significantly reduced in both groups (P=0.01 for the horizontal offset group and P<0.01 for the oblique muscle weakening group).

CONCLUSION

Oblique muscle weakening surgery and horizontal muscle offset are effective in the correction of V pattern when the amount of pattern is under 30Δ.

Augmented medial rectus recession, medial rectus recession plus Faden, and slanted medial rectus recession for convergence excess esotropia

PURPOSE

To evaluate the efficacy of 3 different surgical techniques for convergence excess esotropia: augmented medial rectus recession, medial rectus recession plus Faden, and slanted medial rectus recession.

METHODS

Twenty-nine patients with convergence excess esotropia were divided into 3 groups. Group A included 9 patients treated with medial rectus muscle recession augmented with 1-2 mm more of the standard recession. Group B included 10 patients treated with standard recession plus Faden. Group C included 10 patients treated with slanted medial rectus recession. Surgical success was defined as esotropia (ET) 10 prism diopters (Δ) or less at distance and near with collapse of distance/near disparity.

RESULTS

Satisfactory alignment with elimination of bifocal correction was noted in group A (66.6%). In groups B and C, the results were 70%. Group A patients had a mean reduction in distance/near disparity from 15.5±1.5Δ prism diopters preoperatively to 4.7±2.5Δ prism diopters postoperatively, while in group B the preoperative distance/near disparity was 16.5±1.8Δ prism diopters and decreased to 3.8±3.1Δ prism diopters postoperatively, and group C also showed reduction in distance/near disparity from 18.1±1.6Δ prism diopters preoperatively to 4.5±3.6Δ prism diopters postoperatively. There were no statistically significant differences among the 3 groups.

CONCLUSIONS

The 3 procedures are effective surgical options to treat convergence excess esotropia with acceptable motor outcomes.