Sixteen patients with large angle infantile esotropia with deviations of 80-90 prism dioptres were operated at the age of about 2 years. All patients underwent 8 mm bilateral medial rectus recessions. At the last follow up examination, 6 to 48 months postoperatively (average 16-3 months), successful horizontal alignment was achieved in 12 patients (75%). Four patients (25%) were undercorrected. Clinically significant limitation of adduction or convergence was not observed postoperatively in any of the patients. Consecutive exotropia was not encountered in this series but a longer follow up is probably needed in order to assess its delayed appearance. These results suggest that 8 mm recession of the medial recti is an effective procedure for the correction of large angle infantile esotropia of 80-90 prism dioptres and can be considered as an acceptable alternative to operations on three or four muscles. (BrJ7 Ophthalmol 1994; 78: 842-844) Unilateral recession of the medial rectus combined with resection of the lateral rectus or bilateral recession of the medial recti have been traditionally used in the surgical treatment of infantile esotropia. In deviations exceeding 50 prism dioptres, operations on three or four muscles have been used. In recent years there has been a tendency towards the bilateral recession of the medial recti. In large angle infantile esotropia, a number of authors'" propose augmented recessions of the medial recti instead of operating on three or four muscles. In the past, large recessions ofthe medial rectus ofmore than 6 mm were avoided for fear of producing adduction deficits. The safety and efficacy of the 7 mm recession has already been proved,2"7 and some have proposed even larger recessions. 3 48 The purpose of this paper is to report the results we obtained after performing 8 mm recessions of the medial recti in patients with large angle infantile esotropia with deviations of 80 to 90 prism dioptres. Patients and methods The records of 165 patients who underwent surgery for infantile esotropia by one of the authors (AGD) were reviewed. Sixteen patients met the criteria for inclusion in this study, which were as follows: (1) esotropia documented by an ophthalmologist before the sixth month of age; (2) alternation offixation; (3) preoperative deviation of 80 to 90 prism dioptres treated with 8 mm bilateral medial rectus recession; and (4) more than 6 months' postoperative follow up. Age at surgery ranged from 18 to 38 months, with a mean of 26-6 months (in 10 of the 16 patients age at operation was less than 2 years).Since the measurement of the deviation at distance is usually not possible in the first years of life, we measured the preoperative and postoperative angle at near using alternate cover test and accommodative targets. In a few patients in whom the cover test could not be used accurately, the angle was estimated by the Krimsky method. The accommodative component was excluded preoperatively with cycloplegic refraction with the use of cyclopentolate 1% and full c...
Cataract surgery is not a common cause of persistent diplopia. However, this report highlights that prevalence of diplopia related to cataract is high among cases of diplopia in general, with diplopia being mostly vertical (p=0.001), affecting females (p=0.006), and being more common in left eyes, although results did not reach statistical significance (p=0.133).
These results suggest that bilateral recession of the medial recti based on the near deviation is effective in eliminating the near angle in convergence excess esotropia. In patients with distance orthophoria this operation can be used as an initial treatment instead of bifocals. Although the risk of consecutive exotropia was low in this series, a larger number of patients would determine its actual rate more accurately.
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