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. 2014 May 23:8:1039-45.
doi: 10.2147/OPTH.S59036. eCollection 2014.

Comparative study of Y-split recession versus bilateral medial rectus recession for surgical management of infantile esotropia

Nermeen Badawi  1 , Khaled Hegazy  1
Affiliations

Comparative study of Y-split recession versus bilateral medial rectus recession for surgical management of infantile esotropia

Nermeen Badawi et al. Clin Ophthalmol. .

Abstract

Aim: This prospective study compares the results of bilateral medial rectus recession versus (vs) Y-split recession of medial recti techniques for surgical management of essential infantile esotropia.

Patients and methods: Thirty patients were included in this study and had preoperative infantile esotropia with large angles (ie, >30 prism diopters [PD]). Patients were divided into Group A, which underwent bilateral medial rectus (BMR) recession and Group B, which underwent bilateral Y-split recession of medial recti muscles. All patients were subjected to complete ophthalmologic examination and met the criteria for inclusion in this study. The degrees of BMR recessions performed ranged from 6.0-7.5 mm. All operations were performed under general anesthesia. Follow-up visits were conducted at 1 and 2 weeks, and 1, 3, and 6 months postoperatively. Rates of reoperation for residual esotropia and consecutive exotropia were determined.

Results: The patients' preoperative angles of deviation ranged from 30-80 PD. Group A consumed 57% less operative time than Group B. Immediately postoperatively, the Y-splitting technique showed satisfactory results (ie, orthotropic or residual angles ≤15 PD) in 73% of patients vs 67% only for the BMR recession patients. By the end of six months of follow up; 13% of the BMR technique patients vs 27% of the Y-splitting technique patients showed negative change of PD but without reoperation.

Conclusion: Our results suggest that, although the Y-splitting technique is more difficult and time consuming, both procedures are effective and have shown comparable results for the correction of horizontal deviation ≤70 PD.

Keywords: BMR recession; Y-splitting technique; faden operation; oculomotor pathology; strabismus; torque reduction.

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Figures

Figure 1
Figure 1
Y-split recession, side view. Notes: (A) The first orientation point (a) is determined by the natural midpoint of the muscle insertion. The second orientation point (b) is located 6 mm directly behind a. With a compass, the distance ra is marked with colored dye on the globe. The same procedure is repeated from b, with the distance rb marked with colored dye as well. The intersections of the two marked lines indicate the new insertion points for the split muscle halves. (B) The control distance (c) ensures the correct placement of the new insertion points.
Figure 2
Figure 2
Steps in Y-split recession. Notes: (A) The MR is hooked. (B) A 15 mm distance from the insertion is measured. (C) The muscle is split along the 15 mm. (D and E) The upper and lower MR halves are sutured. (F) The minimum distance from the limbus to the new insertion is measured. (G and H) The two muscle halves are sutured at the new insertion points. Abbreviation: MR, medial rectus.
Figure 3
Figure 3
Patients’ profiles showing patients’ distribution by age. Abbreviation: BMR, bilateral medial rectus.
Figure 4
Figure 4
Immediate postoperative results. Abbreviations: PD, prism diopters; XT, exotropia; BMR, bilateral medial rectus; vs, versus.
Figure 5
Figure 5
Postoperative results at 6 months’ follow-up. Abbreviation: BMR, bilateral medial rectus.
See this image and copyright information in PMC

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