Combined recession and resection surgery in the management of convergence excess esotropia with different levels of AC/A ratio

Somer, Deniz; Cinar, Fatma Gul; Oral, Baris; Örnek, Firdevs

doi:10.1016/j.jaapos.2016.09.029

Cited by 15 publications

(18 citation statements)

References 22 publications

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“…Additional studies, both retrospectively and prospectively, have found that strabismus surgery, specifically unilateral and BMR recessions as well as combined resection and recession of medial rectus, may be an effective alternative to long-term use of bifocals in treating patients with high AC/A ratio ET. [ 15 16 17 18 19 ] Patients in these studies had good sensory and alignment outcomes in this setting. [ 15 16 17 18 ] While our study focused on patients who had residual misalignment despite refractive correction with or without bifocal, we found that surgery in these patients with a high AC/A ratio yields similar outcomes to patients with nonaccommodative ET and a normal AC/A ratio.…”

Section: Discussionmentioning

confidence: 95%

“…[ 15 16 17 18 19 ] Patients in these studies had good sensory and alignment outcomes in this setting. [ 15 16 17 18 ] While our study focused on patients who had residual misalignment despite refractive correction with or without bifocal, we found that surgery in these patients with a high AC/A ratio yields similar outcomes to patients with nonaccommodative ET and a normal AC/A ratio. Surgery may ultimately be preferred over bifocal correction once distance deviation deteriorates to greater than 10Δ.…”

Section: Discussionmentioning

confidence: 99%

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Surgical outcomes for esotropia in children with high accommodative convergence/accommodation ratio

Dass

Cheng

Bahl

2021

Indian Journal of Ophthalmology

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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.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Surgical outcomes for esotropia in children with high accommodative convergence/accommodation ratio

Dass

Cheng

Bahl

2021

Indian Journal of Ophthalmology

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“…Combined recession-resection is a technique that was rst described by Scott AB (1994) in combination with adjustable sutures to correct horizontal incomitant strabismus (14). The technique was further modi ed and investigated by many surgeons who used it to correct both horizontal and vertical incomitance with promising results (15,(21)(22)(23)(24)(25)(26) This technique acts in variable suggested ways, one mechanism is by changing the functional insertion of the muscle after rendering part of it inactive by resecting it, another proposed mechanism is anterior displacement of the orbital layer of the muscle's pulley thus establishing a new relation between the recessed insertion and the anteriorly displaced pulley (20,21). One possible explanation is extirpating the proprioceptive impulses at the myotendinous junction thus interrupting centrally driven incomitant motility disorders (22,26) Combined recession-resection of the superior rectus offers a relative advantage over the retro-equatorial posterior xation sutures that require adequate posterior exposure -which could be challenging in some cases-with an increased risk of haemorrhage, muscle scarring, superior oblique injury and di cult reversibility (27) .Moreover, it is theoretically advantageous over large recession of the superior rectus muscle which commonly results in incomitance manifested by correction of DVD in abduction more than in adduction which was not recorded in any of the patients in our study (28)…”

Section: Resultsmentioning

confidence: 99%

“…In cases of near-distance disparity esotropia, Fermont et al performed a recession (8mm) slightly exceeding the amount of resection (6mm) (30) while Ghali MA and Somer et al recommended resection of 2.5 mm combined with recession according to near angle (22,26) We adopted a modi cation of this technique with resection of 2.5 mm combined with recession based on the angle of DVD using the established nomogram.…”

Section: Resultsmentioning

confidence: 99%

Combined Recession–Resection of The Superior Rectus Muscle in the Treatment of Dissociated Vertical Deviation.

Mattout

Fouda

2021

Preprint

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Purpose This is retrospective study that evaluates the use of combined recession-resection of the superior rectus muscle in the treatment of dissociated vertical deviation (DVD) Methods The medical records of 21 patients with bilateral DVD were retrospectively reviewed. Preoperative data were extracted for age, gender, BCVA (logMAR), amblyopia, angle of stereopsis, previous strabismus surgeries and angle of deviation. All included patients received resection of 2.5 mm of the superior rectus muscle prior to its recession in an amount determined by the maximum DVD angle. The main outcome measure was postoperative angle of DVD at the end of six postoperative months and success was identified as absence of manifest DVD . Results The mean angle of preoperative DVD was 18.09 PD in the right eye and 16.76 PD in the left ‎eye‎. The mean amount of SR recession was 8.9 ‎±1.4 ‎mm in the right e‎‎ye and 8.7 ‎±1.5 in the left ‎eye with symmetrical surgery performed in only 7 patients. Mean postoperative angle of DVD was ‎5.96‎ in the right eye and ‎5.86 ‎in the left eye. Surgical success was achieved in 15 patients (71%). Conclusions Combined recession-resection of the superior rectus muscle seems to be an effective technique in the management of DVD and could represent a good alternative to other surgical procedures.

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“…11 The combined recession/resection surgery of the same rectus muscle, using more classical surgical procedures, has drawn our attention. It was first proposed for the treatment of infantile nystagmus 12 and more recently incomitant strabismus, [13][14][15][16][17][18][19][20] especially convergence excess, very effectively. We tried to evaluate its effectiveness when used on both MR muscles, in PTEs, compared to the isolated modified Fadenoperation.…”

Section: Introductionmentioning

confidence: 99%

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

Fremont

Thouvenin

2021

European Journal of Ophthalmology

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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.

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Combined recession and resection surgery in the management of convergence excess esotropia with different levels of AC/A ratio

Cited by 15 publications

References 22 publications

Surgical outcomes for esotropia in children with high accommodative convergence/accommodation ratio

Surgical outcomes for esotropia in children with high accommodative convergence/accommodation ratio

Combined Recession–Resection of The Superior Rectus Muscle in the Treatment of Dissociated Vertical Deviation.

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

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