Single eye surgery by hang-back recession vs muscle transplantation in large-angle esotropia

Abstract

Background A two horizontal muscle surgery cannot treat a very large angle of esotropia of more than 80 prism diopters (pd). A single eye surgery would not correct such a large angle. Supramaximal recession and resection would lead to restriction of ocular motility. True muscle transplantations have been tried for this abnormally wide-angle esotropia. Purpose The aim was to compare monocular surgery by hang-back recession vs muscle transplantation, regarding the technique, the expected results, and the possibility of minimizing the risk of complications, such as scleral perforation and a lost or slipped muscle. Patients and methods The study is a prospective and nonrandomized study that was held at the Ophthalmology Department, Al-Azhar University Hospitals, Egypt, during the period between May 2016 and May 2018 on 30 patients presenting with esotropia. A total of 15 patients had undergone medial rectus recession using the hang-back technique and 15 patients had undergone medial rectus recession with muscle transplantation. Conjunctival recession was done at the end of surgery, and lateral rectus resection was done in both groups. Their ages ranged from 4 to 58 years. Overall, 19 patients were males and 11 were females. Results There were nonstatistically significant differences between the two groups in all the follow-up visits. Conclusion True muscle transplantation is a safe alternative option and as effective as hang-back technique for large-angle esotropia. The procedure is stable in the long term, with some motility limitation in maximum adduction.