Limits...
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

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.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4043800&req=5

f2-opth-8-1039: 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.

Mentions: At the end of the procedure, the angle between the two muscle parts was measured by a compass to ensure adequate splitting, and was found to be 62.8±5.7°. A detailed description of the surgical technique has been presented previously by Hoerantner et al.18 First, the muscle is hooked and isolated (Figure 2A), then a distance of 15 mm is measured from the insertion point (Figure 2B), and the muscle is split with scissors along the length of 15 mm (Figure 2C). The upper and lower muscle halves are sutured (Figure 2D and E), then disinserted. To obtain the correct new insertion points for the two muscle halves, we employed the procedure indicated in the side view in Figure 1; to ensure that the marks are placed correctly, we suggest measuring the minimum distance between the cornea limbus and the new insertion (control distance, as in Figure 2F). This provides a simple check if the two new insertions of the muscle parts are correct. Then, the two muscle halves can be sutured at the two new insertion points (Figure 2G and H).


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

Badawi N, Hegazy K - Clin Ophthalmol (2014)

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.
© Copyright Policy
Related In: Results  -  Collection

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

f2-opth-8-1039: 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.
Mentions: At the end of the procedure, the angle between the two muscle parts was measured by a compass to ensure adequate splitting, and was found to be 62.8±5.7°. A detailed description of the surgical technique has been presented previously by Hoerantner et al.18 First, the muscle is hooked and isolated (Figure 2A), then a distance of 15 mm is measured from the insertion point (Figure 2B), and the muscle is split with scissors along the length of 15 mm (Figure 2C). The upper and lower muscle halves are sutured (Figure 2D and E), then disinserted. To obtain the correct new insertion points for the two muscle halves, we employed the procedure indicated in the side view in Figure 1; to ensure that the marks are placed correctly, we suggest measuring the minimum distance between the cornea limbus and the new insertion (control distance, as in Figure 2F). This provides a simple check if the two new insertions of the muscle parts are correct. Then, the two muscle halves can be sutured at the two new insertion points (Figure 2G and H).

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