Paper 25

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Comparison Between Augmented Recession and Medial Rectus Recession with Posterior Scleral Fixation in Partially Accommodative Esotropia

 Ghada I. Gawdat, MD; Ahmed A. Awadein, MD, FRCS; Huda H. Al-Hayouti, MD, FRCS; Hala H. Elhilali, MD
Cairo University
Cairo Egypt

Introduction:  Surgery for partially accommodative esotropia (PAET) has been to correct the residual angle that was not corrected with glasses. The most common approaches are the standard and augmented surgeries.

Methods:  This was a prospective randomized interventional study comparing augmented medial rectus (MR) muscle recession to MR muscle recession with posterior scleral fixation (Faden) in children with PAET and normal accommodative convergence to accommodation ratio (AC/A). Surgery was performed on 53 patients: 25 in the Augmented group, and 28 in the Faden group. Patients were followed up at 1, 3 and 6 months postoperatively. Pre- and postoperative angles of deviation and the angle disparity, i.e. the difference between smallest and largest angles, were analysed.

Results:  The surgical target angle and amount of MR recession were significantly less for the Faden versus the Augmented group (P < 0.01). The overall success in the Augmented and Faden groups were 48% and 64% respectively (P > 0.05). The success rate was higher in the Faden group for the near and distance uncorrected angles (P < 0.05), and for patients with preoperative angle disparity > 20 prism dioptres (P < 0.05).

Discussion:  This was the largest prospective randomized study investigating the effect of Faden on PAET with normal AC/A ratio. |MR recession with Faden is superior to augmented MR recession in cases of large preoperative angle disparity. In addition it has a more pronounced effect on the angles of deviation without glasses.|

Conclusion:  Faden targets the angles without correction which could be of cosmetic importance to the patients.

References:  Wright KW, Bruce-Lyle L. Augmented surgery for esotropia associated with high hypermetropia. J Pediatr Ophthalmol Strabismus. 1993;30:167-70.

Klainguti G, Strickler J, & Presset C. Strabisme convergent accommodatif partiel avec et sans excès de convergence. Traitement chirurgical. Klinische Monatsblätter für Augenheilkunde 1996;208.05: 352-355.

Damanakis A, Ikonomopoulos N, Alatski M, Arvanitis P.Effect of posterior fixation sutures on the accommodative element of partially accommodative strabismus. Ophthalmologica. 1994;208:71-76.

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