Bimedial hang-back recession— outcomes and surgical response

Abstract

Aim To report outcomes and identify factors affecting surgical response for constant esotropia using 'hang-back' bimedial rectus recession. Study type Retrospective case series analysis. Methods Patients managed by a single surgeon over a 4-year study period were categorized into esotropia types: infantile, partially accommodative, nonaccommodative and secondary esotropia. Postoperative alignment was compared between types, and regression modelling used to examine factors predicting surgical response. Results In all, 95% (18/19) of children with partially accommodative esotropia achieved postoperative deviation o15 prism dioptres from orthotropia, compared to 56% (15/27) of children with infantile esotropia, 69% (11/16) of children with non-accommodative esotropia and all (2/2) of those with secondary esotropia. Surgical response (D/mm recession performed) increased with the magnitude of both preoperative deviation (Po0.001) and anisometropia (Po0.001); the effect of deviation on surgical response was reduced by amblyopia (P ¼ 0.02). Age at surgery was statistically associated (P ¼ 0.002) but had negligible clinical effect on response. Conclusions Surgical response to hang-back recession may be partially predicted by preoperative factors.

The Comparison of the Strabismus Cases Who Underwent Conventional Recession Surgery with the Cases Who Underwent Hang-Back Recession

“…Hemmerdinger ve ark. (11) ise geriye askı tekniğinin başarısının cerrahi öncesi değerlendirilmelerle kısmen ön gürülebileceğini öne sürmüşlerdir.…”

“…Bu çalışmaların genelinde standart teknik ile benzer başarılar bildirilirken, bazılarında konvansiyonel geriletme daha başarılı olarak bildirilmiştir (11,12) . Rodrigues ve Nelson, 42 XT olgusunda dış rektus (DR) kaslarının askı tekniği ile veya klasik yöntem ile geriletilmesi sonucu benzer sonuçlar bildirmişlerdir (8) .…”

Comparison of hang-back and conventional bimedial rectus recession in infantile esotropia

“…Possible advantages for this technique include easier surgical exposure and reduced risk for scleral perforation [5][6][7][8][9][10] as well as shorter surgery duration [8,9]. This study compares hang-back and conventional bimedial rectus muscle recession in patients with infantile esotropia.…”

“…They found a success rate of 82% for this procedure compared to 80% for the conventional surgery. Recent studies [7][8][9][10] agree that the hang-back recession method is an effective alternative to traditional techniques with success rates of 55% [7], 60% [8], and 73% [10] for esotropia.…”

Infantile-Onset Esotropia

“…Motor fusion can be normal in the absence of sensory fusion but not the reverse. Any defect in motor fusion fails to help both eye globes to sustain a normal binocular vision that leads one of them to block the eye in adduction position to receive the second image on the less mature nasal retina [3].…”