Abstract
Purpose :
To evaluate the clinical safety and efficacy of the novel Wright hang-back recession with fibrin glue for the treatment of horizontal strabismus. Scleral/Retinal perforation is a serious complication of rectus muscle recessions. Hang-back recession reduces this complication, but the muscle may not adhere at the desired position, increasing the risk of late posterior slippage and over-correction or anterior muscle creep and under-correction.
Methods :
The medical records of all patients who underwent strabismus surgery by one skilled strabismus surgeon between 2016-2018 for horizontal deviations only, including cases of WHBG (Group 1) or SFR (Group 2), were retrospectively reviewed. Post-operative follow-up periods were divided into early (1-7 days) and intermediate (2-8 months). The main outcome measure was surgical outcomes of each group. Good surgical outcome was defined as a post-operative deviation (PD) of less than or equal to 10 PD at a minimum follow-up of 2 months.
Results :
32 eyes of 17 patients underwent WHBG and 32 eyes of 17 patients underwent SFR. Patient demographics were similar between groups. Patients ranged from 2.5-77 years of age. In each group, 35% of patients had an esotropia and 65% had an exotropia. Preoperative deviations in the two groups were similar with mean esotropia 25.5 PD and mean exotropia 26.6 PD in the WHBG group, and mean esotropia 28.3 PD and mean exotropia 23.8 PD in the SFR group. The mean post- operative deviation was less than 7 PD for both groups. Median intermediate follow-up was 4 months for both groups. Good surgical outcomes were similar between groups, 16/17 (94%) in the WHBG and 15/17 (88%) in the SFR. There were no complications in either group.
Conclusions :
WHBG recession was safe and effective with post-operative results not significantly different than SFR. WHBG eliminates the complication of retinal perforation that can occur with SFR whilst avoiding under- or overcorrection that can occur with traditional hang-back recession. WHBG resulted in as good surgical results as SFR, with no complications. This technique increases patient safety without sacrificing surgical outcomes and can be especially useful in patients with thin sclera such as patients with high myopia or those with difficult posterior exposure.
This is a 2020 ARVO Annual Meeting abstract.