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

Badawi N, Hegazy K - Clin Ophthalmol (2014)

Bottom Line: Group A consumed 57% less operative time than Group B.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.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.

View Article: PubMed Central - PubMed

Affiliation: Ophthalmology Department, Faculty of Medicine, Menoufiya University, Shebin El-Kom, Menoufiya, Egypt.

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.

No MeSH data available.


Related in: MedlinePlus

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.
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f1-opth-8-1039: 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.

Mentions: For the Y-split recession, both MR muscles were split at a length of 15 mm, and the two parts were reinserted on the globe surface with two non-absorbable sutures. First, the muscle was carefully cut using blunt West cottscissors (Acme United Corporation, Fairfield, CT, USA) along a length of 15 mm, avoiding damage to the nutritional vessels. To obtain the correct new insertion points for the two muscle halves, we employed the following procedure. A first orientation point, labeled (a), was located in the middle of the natural insertion of the muscle. A second point, labeled (b), was located 6 mm directly behind (a). With the compasses centered at (a), the distance we defined as ra was marked on the globe with methylene blue (Figure 1). The same procedure was repeated from point (b), with the distance rb. The intersection point of the two methylene blue lines (c) marked the new insertion point of the first muscle half.


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

Badawi N, Hegazy K - Clin Ophthalmol (2014)

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.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4043800&req=5

f1-opth-8-1039: 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.
Mentions: For the Y-split recession, both MR muscles were split at a length of 15 mm, and the two parts were reinserted on the globe surface with two non-absorbable sutures. First, the muscle was carefully cut using blunt West cottscissors (Acme United Corporation, Fairfield, CT, USA) along a length of 15 mm, avoiding damage to the nutritional vessels. To obtain the correct new insertion points for the two muscle halves, we employed the following procedure. A first orientation point, labeled (a), was located in the middle of the natural insertion of the muscle. A second point, labeled (b), was located 6 mm directly behind (a). With the compasses centered at (a), the distance we defined as ra was marked on the globe with methylene blue (Figure 1). The same procedure was repeated from point (b), with the distance rb. The intersection point of the two methylene blue lines (c) marked the new insertion point of the first muscle half.

Bottom Line: Group A consumed 57% less operative time than Group B.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.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.

View Article: PubMed Central - PubMed

Affiliation: Ophthalmology Department, Faculty of Medicine, Menoufiya University, Shebin El-Kom, Menoufiya, Egypt.

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.

No MeSH data available.


Related in: MedlinePlus