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A.–S. Petavy–Blanc, N. Fayol, A.C. Ott, C. Feumi–Jantou, G. Jounda, A. Bousquet, E. Barreau; Bilateral Medial Rectus Recession Combined With Retroequatorial Myopexy as a Surgical Treatment of Large Angle Esotropia at Distance Fixation . Invest. Ophthalmol. Vis. Sci. 2006;47(13):2473.
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We performed a prospective study to evaluate the effectiveness and predictability of bilateral medial rectus recession associated with retroequatorial myopexy for large angle esotropia. This technique is a well established surgical procedure in the treatment of near–distance disparity esotropia. Our aim was to explore whether it is also an appropriate method to reduce large angle esotropia at distant fixation.
20 patients, aged 3,8 – 20 years (mean 8,9 years), were included in the study. Inclusion criteria were stable and persistent large angle esotropia ≥ 40 PD at distant fixation after full optical correction of refractive errors and no prior surgery. All patients were treated by a conventional bimedial rectus recession based on the distance angle of esotropia associated with retroequatorial myopexy. The myopexy was placed 12, 13 or 14 mm behind the insertion of the medial rectus muscle. Postoperative follow up ranged from 3 to 42 months (mean 17 months).
18 of 20 patients had a satisfying surgical result, which had been defined as esotropia < 15 PD and exotropia < 10 PD at distance. 70 % (n = 14) of the patients who had a satisfying result were orthotropic for distance and near fixation. Mean preoperative esotropic angle deviation was 48,25 PD. Residual esotropia (> 15 PD) was observed in 15 % at 1 month and in 10 % at last follow–up (maximal deviation 20 PD). Consecutive exotropia > 10 PD was found in 5 % at 1 month but was not observed at last follow–up. The surgical result fulfilled our aimed criteria in 80 % at 1 month and in 90 % at last follow–up.
Bilateral medial rectus recession associated with retroequatorial myopexy seems to be a safe and effective surgical procedure giving predictable results in the treatment of large angle esotropia at distant fixation. It permitted successful correction of large angle deviation and provided a satisfying aesthetic alignment.
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