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. 2017 Oct 17:11:1877-1881.
doi: 10.2147/OPTH.S143773. eCollection 2017.

Bimedial rectus muscle elongation versus bimedial rectus muscle recession for the surgical treatment of large-angle infantile esotropia

Manar A Ghali  1
Affiliations

Bimedial rectus muscle elongation versus bimedial rectus muscle recession for the surgical treatment of large-angle infantile esotropia

Manar A Ghali. Clin Ophthalmol. .

Abstract

Purpose: To compare bimedial rectus muscle recession (BMRR; 7-8 mm) and bimedial rectus muscle elongation (BMRE; 6.5-9 mm) for the surgical treatment of large-angle infantile esotropia (ET; ≥70 prism diopters [PD]).

Patients and methods: Twenty-four patients with large-angle infantile ET were divided into 2 groups; group A (n=12) underwent BMRR and group B (n=12) underwent BMRE. All patients received surgery under general anesthesia and were followed for at least 24 months after surgery. The mean dose-response effect at 24 months was calculated for each patient.

Results: The mean preoperative angle of deviation was 79.16±7.64 PD (range, 70-90) in group A and 85.83±9.25 PD (range, 70-100) in group B. The duration of surgery was 55% shorter in group A compared with group B. There were no cases of over-correction, but there were 6 cases of under-correction in group A (50%) and 2 cases of under-correction in group B (16.7%). The mean dose-response effect was 4.42±0.19 PD/mm in group A and 5.45±0.39 PD/mm in group B.

Conclusion: BMRE is more effective than BMRR for the surgical treatment of large-angle infantile ET despite a higher level of technical difficulty.

Keywords: bimedial rectus muscle elongation; bimedial rectus muscle recession; large-angle infantile esotropia; surgical treatment of infantile esotropia.

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Conflict of interest statement

Disclosure The author reports no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Limbal conjunctival incision and isolation of medial rectus muscle; the tendon width must be 8 mm or more. Courtesy of Dr Sherif El Far.
Figure 2
Figure 2
Splitting of the muscle longitudinally into 3 parts; the width of central section is double that of the peripheral sections. Courtesy of Dr Sherif El Far.
Figure 3
Figure 3
The peripheral sections were clamped and incised at a distance of 6.5–9 mm from insertion. Courtesy of Dr Sherif El Far.
Figure 4
Figure 4
Securing of the wider central section with O/6 polyglactin (Vicryl) sutures (Ethicon Inc., Somerville, NJ, USA). Courtesy of Dr Sherif El Far.
Figure 5
Figure 5
Cutting of the central section anterior to the sutures and in flush with the sclera. Courtesy of Dr Sherif El Far.
Figure 6
Figure 6
The central portion was detached from the insertion. Courtesy of Dr Sherif El Far.
Figure 7
Figure 7
The distal ends of the peripheral sections were sutured to the cut end of the central portion. Courtesy of Dr Sherif El Far.
See this image and copyright information in PMC

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