Bilateral combined resection-recession of the same rectus muscle versus Fadenoperation for treatment of purely tonic esotropias

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.

Combined recession and resection of the same lateral Rectus in the treatment of exotropia

“…We chose to place the LR far enough to suppress as much as possible its arc of contact without taking a risk of under-action; 10mm behind its former insertion seemed a good compromise. In our previous case series of RRSM for esotropia, 10 the amount of resection and recession was the same for all cases given that RRSM was used to treat overactive muscles regardless of the amount of overaction. However, when performing RSSM of LR for exotropia, if we observed 91% of angle reduction under GA, very few cases were in orthoposition under GA, i.e., purely tonic (17 cases).…”

“…Anesthesia included controlled curarization (e.g., rocuronium) as previously described. 10 Strabismus angle under GA was evaluated for each eye using the corneal light reflection under the microscope (Hirshberg method) with an accuracy of approximately +/- 5PD. 13,14,15 This remains more of an evaluation than a measure to easily validate the main study inclusion criteria and had no influence on the surgery performed.…”

“…In a previous study on RRSM of the MR in esotropia, we proposed an 8mm-recession with a 5mm-resection. 10 For the LR, we increased recession to 10mm because of the longer arc of contact. Recession was further increased in myopic eyes < -6D (recession 11mm from −6 to −9, 12mm over −9, no cases had myopia over −11) and reduced in highly hyperopic eyes >+6D (recession 9mm from +6 to +9, 8mm over +10, no cases over +10).…”

“…Combined Recession and Resection on the Same Muscle (RRSM) has been found effective for overactive MR. 7,8,9,10 with a “Faden-like” effect. Elsewhere, RRSM has recently been proposed to treat true divergence excess exotropia with promising early results.…”

Comparison of three different surgical techniques for convergence excess esotroia

“…Up till now the best and the most effective technique with stable results is still under research. Bilateral medial rectus recession [7]Augmented medial rectus recession [8], bilateral medial rectus recession with retro equatorial myopexy [9], y splitting recession [10]and slanted rectus recession [11][12] [13] are different methods for the surgical treatment [14] Many studies provided increasing suggestion that BMRR is an effective and secure operation in treating esotropia with NFD [7][14] [15]. If correction depend on the far angle of deviation, high degrees of under correction will progress and if based on the near angle, consecutive exotropia will progress [2] [7] For the treatment of CEET with NFD; many researches supported the procedure of bilateral CRR of MR muscle.…”