Another slant on correcting pattern strabismus

Comparison of surgical outcomes of slanted procedure for exotropia with convergence insufficiency according to their response to preoperative monocular occlusion

The aim of this prospective study was to compare surgical outcomes of slanted bilateral lateral rectus (LR) recession for intermittent exotropia (IXT) with convergence insufficiency (CI) according to their response to preoperative monocular occlusion. This prospective study included 55 children who underwent slanted bilateral LR recession for IXT with CI. Patients were divided into two groups according to their response to preoperative monocular occlusion for 2 hours. The True CI group was defined as having near-distance differences of ≥10 PD before and after occlusion; the Masked CI group as having near-distance differences of <10 PD and ≥10 PD prior to and after occlusion. Slanted procedure reduced distance and near exodeviations from 32.1 PD and 43.0 PD to 3.5 PD and 4.4 PD, and collapsed near-distance differences from 10.9 PD to 1.0 PD at 3 years postoperatively. Cumulative probabilities of surgical success were 76%, and the mean recurrence was 50 months at 3 years postoperatively; the True CI and Masked CI groups showed cumulative success rates of 89% and 55%, respectively (p = 0.0052). Patients in the True CI group demonstrated surgical outcomes superior to those demonstrated by patients in the Masked CI group after slanted bilateral LR recession.

Early results of slanted recession of the lateral rectus muscle for intermittent exotropia with convergence insufficiency

The aim of this study was to evaluate the efficacy of slanted recession of the lateral rectus muscle for intermittent exotropia with convergence insufficiency. This prospective study included 31 patients who underwent slanted lateral rectus recession for intermittent exotropia with convergence insufficiency between June 2010 and June 2012. Following parameters were recorded and analyzed: patient sex, age, preoperative and postoperative near and distance ocular alignment, and changes in stereopsis. The mean age of the patients was 9.2 years. The preoperative mean deviation angle was 32.4 PD at distance and 43.4 PD at near. After 6 months, slanted lateral rectus recession reduced the deviation angles to 2 PD at distance and 3.4 PD at near. In addition, the mean difference between distance and near deviation angles was significantly reduced from 11 PD to 1.4 PD at 6 months postoperatively. Slanted lateral rectus recession for intermittent exotropia with convergence insufficiency in children successfully reduced the distance and near exodeviations and the near-distance difference without increasing the risk of long-term postoperative esotropia or diplopia.

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.

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.