A New Approach to Treat Esotropia in Patients with Large V-Pattern
Moustafa S. Abdelhafez, FRCS, MD
Magrabi Eye Hospital
Jeddah, Saudi Arabia
Introduction: To find alternative surgical approach for correction of esotropia in primary position.
Methods: Six patients aged from eight months to five years. Their orthoptic evaluation revealed esotropia in primary position varied from 12 to 25 prism diopter (PD), large V-pattern with bilateral hypertropia for both eyes. All of them had not less than esotropia 30 PD on down gaze. The V-pattern was as large as 25 PD or more. There were bilateral inferior oblique overaction from +3 to +4. We did, for all patients, asymmetric bilateral inferior oblique recession in addition to equal bilateral inferior rectus recession.
Results: Reduction of amount of esotropia in primary position by mean of 13.6 PD (±5.55), and in down gaze by mean of 28.8 PD (±7.66). V-pattern collapsed by mean of 28.8 PD (±8.4). Bilateral large inferior oblique overaction disappeared completely.
Discussion: By using the new approach, significant reduction of esotropia in primary position (P<0.05). Bilateral inferior rectus recession decreases esotropia in down gaze.
Conclusion: Not only recession of medial rectus will treat esotropia in primary position. But, correction of esotropia can be achieved also by bilateral recession of inferior rectus and inferior oblique.
References: David R. Stager. Anterior & Nasal Transposition of the Inferior Oblique Muscles. Journal of AAPOS, volume 7, number 6, June 2003: 167-173.