1
|
Thouvenin D, Lequeux L, Bonifas C, Deboutte I. Combined recession and resection of the same lateral Rectus in the treatment of exotropia. Eur J Ophthalmol 2024; 34:874-879. [PMID: 38361386 DOI: 10.1177/11206721241229318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
BACKGROUND Besides rest position abnormalities, exotropia could also be due to hypertonia of the Lateral Recti (LR) given divergence frequently decreases under general anesthesia (GA). Combined Recession-Resection of the Same Muscle (RRSM) is a promising alternative to the Faden procedure in the surgical treatment of overacting MR in esotropia. We thus examined here the effectiveness of combined RRSM of the LR for the treatment of exotropia that decrease under GA. METHODS We performed a retrospective, single-center evaluation over a 16-month period of 100 patients operated on for exotropia that decreased under deep GA (91% of 110 consecutive operated cases). We excluded re-operations and pure convergence insufficiencies. We performed a combined RRSM of one or two LR. It included a 10mm-recession and a "fine-tuned" resection of LR based on Quantitative Forced Duction Test scores. MR resection was combined when exotropia exceeded 35PD or for unilateral surgery. We report on patient outcomes 6 months after surgery. RESULTS Successful results were obtained (-8-+8 PD measured on Alternate Cover Test) among 83% of cases at distance fixation and 91% at near fixation after 6 months. The Newcastle Control Score also improved from 5.8 to 1.7 after 6 months. No surgery-related complications or repeat surgeries were reported. CONCLUSIONS In our experience a majority of exotropias decrease under GA and our strategy of combined RRSM of the LR is effective for the treatment of such exotropias. Long-term follow-up of the cohort is required to investigate the stability of these outcomes, and confirmation of our results by other works.
Collapse
Affiliation(s)
- Dominique Thouvenin
- Pediatric Ophthalmology and Adult Strabismus unit, Clinique Rive Gauche, 49 allées Charles de Fitte, 31300, Toulouse, France
| | - Léopoldine Lequeux
- Pediatric Ophthalmology and Adult Strabismus unit, Clinique Rive Gauche, 49 allées Charles de Fitte, 31300, Toulouse, France
| | - Christelle Bonifas
- Pediatric Ophthalmology and Adult Strabismus unit, Clinique Rive Gauche, 49 allées Charles de Fitte, 31300, Toulouse, France
| | - Isabel Deboutte
- Pediatric Ophthalmology and Adult Strabismus unit, Clinique Rive Gauche, 49 allées Charles de Fitte, 31300, Toulouse, France
| |
Collapse
|
2
|
Kennedy A, Lengwiler F, Dosanjh S, Jolly R, Jain S. Effect of bimedial recession on near-distance disparity in esotropia. Eye (Lond) 2023; 37:2294-2298. [PMID: 36463328 PMCID: PMC10366172 DOI: 10.1038/s41433-022-02334-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 10/21/2022] [Accepted: 11/25/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Esotropia may be associated with a difference in the deviation at near and distance fixation termed near-distance disparity (NDD). Convention suggests patients with NDD may benefit more from bilateral medial rectus recessions (BMR) as opposed to a unilateral recession/resection (RR). The aim of this study is to establish the effect of BMR for the treatment of esotropia on both the near and distance deviation and NDD. METHODS Retrospective patient records search from 2011 to 2021. INCLUSION CRITERIA comitant esotropia, first surgery, equal and normal vision with free alternation. EXCLUSION CRITERIA incomitant, neurological or restrictive strabismus, previous surgery, clinically significant amblyopia. RESULTS 49 patients met the inclusion criteria. 19 patients were female; the average age was 17 years. Following surgery, the average near deviation reduced from 39PD base out (BO) to 11PD BO. The average distance deviation reduced from 33PD to 9PD. Average preoperative NDD was 12 PD. NDD resolved in 15 out of 18 patients with NDD (83%). The average PD gain per mm of recession was 2.7 for near and 2.2 for distance. CONCLUSIONS BMR is an effective surgical treatment for esotropia and has a greater effect on near deviation than distance. It is also an effective and simple technique for lesser degrees of NDD. BMR has several advantages over RR: no tissue loss, readily reversible, the scars are easier to hide and it avoids potential motility limitations due to leash effects following resection.
Collapse
|
3
|
Mattout HK, Fouda SM. Treatment of Dissociated Vertical Deviation by Combined Recession–Resection of the Superior Rectus Muscle versus Recession with Posterior Fixation Suture. Open Ophthalmol J 2022. [DOI: 10.2174/18743641-v16-e2204180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Management of dissociated vertical deviation (DVD) is still a matter of controversy in strabismus practice. Different surgical techniques are available, ranging from the weakening of the superior rectus or inferior oblique muscles to strengthening of the inferior rectus muscle, with variable success rates.
Objective:
To report the outcomes of correcting DVD by combined recession-resection of the superior rectus muscle and to compare the results with those of superior rectus muscle (SR) recession with posterior fixation sutures.
Methods:
The medical records of patients who had a surgical correction for DVD were retrospectively reviewed. Two groups of patients were identified; Group I (29 patients) was treated with the combined recession –resection of the SR and group II (37 patients) was treated by SR recession with posterior fixation sutures (Faden). Collected preoperative data included age, best-corrected visual acuity, presence of amblyopia, history of previous surgeries and angle of DVD. Operative data such as amount of SR recession and operative time were also extracted. The outcome measures taken at the final postoperative follow up visit included the surgical success rate which is identified as the percentage of patients with absent manifest DVD and the amount of residual latent deviation measured by prism cover test.
Results:
The mean follow-up period for all patients was 22.6 ±4.6 months. In the last follow-up visit, the surgical success rate was 76% in the combined recession-resection group and 73% in the faden group with no significant difference between both groups (p=0.8). No significant difference was found in the residual latent deviation in both groups as well. The recorded surgical time was significantly shorter in the combined recession- resection group (p<0.001). The reported complications included mild, temporary limitation of elevation without hypotropia in 5 patients (2 in group I (7%) and 3 patients in group II (8%)) with no significant difference between both groups (p=0.8).
Conclusion:
Combined recession-resection of SR is as effective as SR recession with posterior fixation suture in the management of DVD with the advantages of easier technique and less surgical time.
Collapse
|
4
|
Dass SE, Cheng M, Bahl RS. Surgical outcomes for esotropia in children with high accommodative convergence/accommodation ratio. Indian J Ophthalmol 2021; 69:2766-2770. [PMID: 34571631 PMCID: PMC8597504 DOI: 10.4103/ijo.ijo_246_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To assess if high accommodative convergence/accommodation (AC/A) ratio impacts surgical outcomes in children with esotropia (ET), and evaluate the appropriate target angle in surgical dosing in the presence of high AC/A ratio. Methods A retrospective chart review identified patients who underwent primary bilateral medial rectus (BMR) recessions for ET. Patients were excluded if follow-up was ≤2 months. Basic demographic information, visual acuity, stereopsis, alignment, and target angle for surgery were collected. High AC/A was defined as ≥10 prism diopter (Δ) deviation at near compared to distance. Outcome parameters were near and distance deviations ≤10Δ within orthophoria, and/or stereopsis postoperatively. Yates' continuity correction, unpaired t-test, regression analysis, and one-way ANOVA were used. Results We identified 103 patients, 23 with high AC/A and 80 with normal AC/A, preoperatively. Mean age was 4.0 ± 2.5 years. Surgical success measured by postoperative alignment was 48% and 45% in the high AC/A and normal AC/A groups, respectively (P = 1.0). There was a statistically significant difference in preoperative near deviation between high AC/A and normal AC/A groups (P = 0.0015); however, there was no significant difference in preoperative distance deviation (P = 0.061). In addition, there was not a significant difference in preoperative or postoperative stereopsis between high AC/A and normal AC/A groups (P = 0.88 and P = 0.44, respectively). There was a significant difference in the normal AC/A and high AC/A groups when target angle was directed toward preoperative near deviation as determined by one-way ANOVA (F = 170.88, P < 0.0001 and F = 14.61, P = 0.0010, respectively). Conclusion In the setting of ET treated with BMR recession, the presence of high AC/A does not affect surgical success as measured by alignment and stereopsis. In addition, when high AC/A is present, surgical dosing with a target angle toward near deviation was found to yield the best surgical outcomes in our patient population.
Collapse
Affiliation(s)
- Sabrina E Dass
- Department of Ophthalmology, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Monique Cheng
- Department of Ophthalmology, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Reecha S Bahl
- Department of Ophthalmology, Wayne State University School of Medicine; Department of Pediatric Ophthalmology and Adult Strabismus, Kresge Eye Institute, St Antoine, Detroit, MI, USA
| |
Collapse
|
5
|
Altintas O, Acar Z, Ozkan B, Elibol O. Augmented Medial Rectus Recession with Non-Absorbable Suture Loops is Effective in the Treatment of Convergence Excess Esotropia. Semin Ophthalmol 2021; 37:227-231. [PMID: 34314286 DOI: 10.1080/08820538.2021.1957944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIM To evaluate the surgical outcomes of augmented medial rectus recession with non-absorbable 5.0 white braided polyester suture (Alcon Laboratories, Forth Worth, Texas, USA) loops in patients diagnosed with convergence excess esotropia. Methods: Clinical records of 21 patients with convergence excess esotropia who have been operated with symmetric medial rectus recessions augmented with non-absorbable suture loops were reviewed. Initial scleral bite was planned according to the distance deviation. Non-absorbable sutures tied leaving a loose loop which was 1 mm for a near-distance disparity of 10 PD, 1.5 mm for 15PD, and 2 mm for 20 PD. Postoperative changes in near-distance disparity were evaluated. RESULTS The mean preoperative near-distance disparity of 17,21 ± 1,68 standard mean of error (SE) prism diopters (PD) decreased to 3,15 ± 0,88 PD SE at 12 month postoperatively. Near-distance disparity of 10 PD or less was achieved in all patients after surgery at the sixth month, 1 patient showed 12 PD of disparity at the first-year control. No overcorrection has been noted. CONCLUSION Bilateral medial rectus muscle recession procedure augmented with polyester suture loops effectively decreases the disparity between near and distance deviations in patients with convergence excess esotropia. Because of our good results and an easy, noninvasive approach without any additional complications, we recommend this technique to treat convergence excess esotropia.
Collapse
Affiliation(s)
- O Altintas
- Department of Ophthalmology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Z Acar
- Haydarpasa Numune Research and Training Hospital, İstanbul-Turkey
| | - B Ozkan
- Department of Ophthalmology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - O Elibol
- Dunya Goz Hospitals, Izmit-Kocaeli
| |
Collapse
|
6
|
Fremont F, Thouvenin D. Bilateral combined resection-recession of the same rectus muscle versus Fadenoperation for treatment of purely tonic esotropias. Eur J Ophthalmol 2021; 32:11206721211008043. [PMID: 33827263 DOI: 10.1177/11206721211008043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To compare the efficiency of bilateral combined resection-recession surgery of the medial rectus muscle versus using a modified Fadenoperation for surgical management of esotropias that totally resolve under general anesthesia, which we called "purely tonic" esotropias. METHODS We included 65 unselected consecutive cases of patients with purely tonic esotropias who underwent surgery between October 2017 and 2018. Patients were divided into group I, who underwent a combined resection and recession of medial recti muscles, and group II, who underwent a bilateral medial rectus Fadenoperation using posterior strapping. A satisfactory outcome was defined as deviation ⩽10 prism diopters (PD), at near and distance fixation, between 3 and 6 months postoperatively. RESULTS Mean initial deviation was in group I, 19.6 PD and 32.0 PD, in group II, 23.6 PD and 33.5 PD, at distance and near fixation respectively. Postoperatively, in group I, 31 patients (91.2%) showed satisfactory alignment at near and distance fixation. Post-operatively, in group II, 25 patients (80.6%) showed satisfactory alignment at near and distance fixation. CONCLUSION Our results suggest both techniques are good options to treat purely tonic esotropias.
Collapse
Affiliation(s)
- Félix Fremont
- Department of Ophthalmology, Centre Hospitalier Universitaire Purpan, Toulouse, France
| | - Dominique Thouvenin
- Department of Ophthalmology, Centre Hospitalier Universitaire Purpan, Toulouse, France
- Rive Gauche Ophthalmological Clinic, Toulouse, France
| |
Collapse
|
7
|
Bagheri A, Abbasnia E, Tavakoli M. Modified Y- split and recession of medial rectus muscles in convergence excess esotropia. Eur J Ophthalmol 2020; 31:3386-3393. [PMID: 33092400 DOI: 10.1177/1120672120965494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The convergence excess esotropia (CEET) is defined when near esotropia is greater than the distance by at least 10 PD while the eye is corrected with the full cycloplegic refraction. The purpose of this study is to evaluate the effect of a modified technique of Y- split recession of the medial rectus muscles on CEET. METHODS This was a retrospective study on patients diagnosed with CEET. The surgery included longitudinally dividing the medial rectus muscles into two equal halves and re-attaching them in a recessed and one-tendon width apart position. Success was defined as a residual distance and near esotropia of less than 10 PD and a distance-near disparity of less than 5 PD. RESULTS Fourteen patients, including 8 (57.1%) females, were enrolled with a mean age of 7.1 ± 2.9 years. The mean follow-up period was 28.6 ± 12.1 months. The mean preoperative distance and near esotropia was 31 ± 10 and 45 ± 11.3 PD respectively that decreased to 2.4 ± 3 and 3.6 ± 3.8 PD at the final visit (p < 0.001). The Mean distance-near disparity of esotropia was 14 ± 4.5 PD before the operation that decreased to 1.3 ± 1.8 PD at the final visit (p < 0.001). The motor success rate was 78.6%, bifocal glasses were no more required in 92.9% of patients, and stereopsis improved in 35.7% of patients after the surgery. CONCLUSION Bilateral modified Y- split and recession of the medial rectus muscle is an effective technique for the treatment of CEET with persistent outcomes in the long-term follow-up.
Collapse
Affiliation(s)
- Abbas Bagheri
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ehsan Abbasnia
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Tavakoli
- Department of Ophthalmology and Visual Sciences, The University of Alabama at Birmingham, Callahan Eye Hospital, Birmingham, Al, USA
| |
Collapse
|
8
|
Elkhawaga M, Elshakankiri N, Helaly H, Elkamshoushy A. Evaluation of fenestration technique of the medial recuts muscle with resection of ipsilateral lateral rectus muscle in patients with sensory esotropia. JOURNAL OF THE EGYPTIAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.4103/ejos.ejos_28_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
9
|
Lembo A, Serafino M, Strologo MD, Saunders RA, Trivedi RH, Villani E, Nucci P. Accommodative esotropia: the state of the art. Int Ophthalmol 2018; 39:497-505. [PMID: 29332227 DOI: 10.1007/s10792-018-0821-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 01/04/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE To review the state of the art of Accommodative Esotropia (AE) through careful study of what has been reported up to the point in literature. METHODS A literature search was done on PubMed using key words including "Accommodative esotropia", "Infantile esotropia", "Strabismus" and "Accommodation". We systematically reviewed and critically appraised what has been written about AE and we tried to analyze that according to the current management of AE. RESULTS Accommodative Esotropia (AE) is a form of strabismus characterized by convergent misalignment of the visual axes that can be associated with hyperopia and abnormal fusional divergence. Also abnormal accommodative convergence/accommodation ratio could be found. In lots of cases, AE initially presents as an intermittent esodeviation at age 1.5 to 4 years. The prevalence of AE has been estimated near 1-2% in the United States. The only treatment with an optical correction usually is successful in re-establishing alignment, but surgical correction is necessary in approximately 30% of cases.
Collapse
Affiliation(s)
- Andrea Lembo
- Department of Clinical Sciences and Community Health, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Multimedica, University of Milan, Eye Clinic San Giuseppe Hospital, Via San Vittore, 12, 20123, Milan, Italy.
| | - Massimiliano Serafino
- Department of Clinical Sciences and Community Health, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Multimedica, University of Milan, Eye Clinic San Giuseppe Hospital, Via San Vittore, 12, 20123, Milan, Italy
| | - Marika Dello Strologo
- Department of Clinical Sciences and Community Health, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Multimedica, University of Milan, Eye Clinic San Giuseppe Hospital, Via San Vittore, 12, 20123, Milan, Italy
| | - Richard A Saunders
- Department of Ophthalmology, Storm Eye Institute, Medical University of South Carolina, Charleston, SC, USA
| | - Rupal H Trivedi
- Department of Ophthalmology, Storm Eye Institute, Medical University of South Carolina, Charleston, SC, USA
| | - Edoardo Villani
- Department of Clinical Sciences and Community Health, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Multimedica, University of Milan, Eye Clinic San Giuseppe Hospital, Via San Vittore, 12, 20123, Milan, Italy
| | - Paolo Nucci
- Department of Clinical Sciences and Community Health, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Multimedica, University of Milan, Eye Clinic San Giuseppe Hospital, Via San Vittore, 12, 20123, Milan, Italy
| |
Collapse
|