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Comparison between medial rectus pulley fixation and augmented recession in children with convergence excess and
Heba M Fouad1, Mohamad A Abdelhakim1, Ahmed Awadein1
1Cairo University Faculty of Medicine, Cairo, Egypt.
Insights
Medial rectus muscle pulley fixation showed a higher success rate than augmented recession for treating esotropia in children. Pulley fixation also resulted in significantly lower postoperative angle deviations and disparity.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Strabismus Surgery
Background:
- Convergence excess esotropia and variable-angle infantile esotropia are common forms of strabismus in children.
- Surgical management aims to correct eye alignment and improve binocular vision.
Purpose of the Study:
- To compare the efficacy of medial rectus (MR) muscle pulley fixation versus augmented recession in children with convergence excess esotropia and variable-angle infantile esotropia.
Main Methods:
- A prospective randomized interventional study involving 60 children with esotropia.
- Patients were randomly assigned to either augmented MR muscle recession or MR muscle pulley posterior fixation.
- Surgical techniques and outcome measures, including angles of deviation and angle disparity, were analyzed.
Main Results:
- The pulley fixation group demonstrated a statistically significant higher success rate (70%) compared to the augmented group (40%) (P = 0.037).
- Postoperative smallest and largest angles of deviation, as well as angle disparity, were significantly lower in the pulley group (P < 0.01).
Conclusions:
- Medial rectus muscle pulley fixation is an effective surgical technique for managing variable angle esotropia and convergence excess esotropia.
- Pulley fixation offers advantages in reducing angle variability and improving outcomes in specific pediatric strabismus cases.
Purpose:
To compare the outcomes of medial rectus (MR) muscle pulley fixation and augmented recession in children with convergence excess esotropia and variable-angle infantile esotropia.
Methods:
This was a prospective randomized interventional study in which children with convergence excess esotropia or variable-angle infantile esotropia were randomly allocated to either augmented MR muscle recession (augmented group) or MR muscle pulley posterior fixation (pulley group). In convergence excess, the MR recession was based on the average of distance and near angles of deviation with distance correction in the augmented group, and on the distance angle of deviation in the pulley group. In variable-angle infantile esotropia, the MR recession was based on the average of the largest and smallest angles in the augmented group and on the smallest angle in the pulley group. Pre- and postoperative ductions, versions, pattern strabismus, smallest and largest angles of deviation, and angle disparity were analyzed.
Results:
Surgery was performed on 60 patients: 30 underwent bilateral augmented MR recession, and 30 underwent bilateral MR recession with pulley fixation. The success rate was statistically significantly higher (P = 0.037) in the pulley group (70%) than in the augmented group (40%). The postoperative smallest and largest angles and the angle disparity were statistically significantly lower in the pulley group than the augmented group (P < 0.01).
Conclusions:
Medial rectus muscle pulley fixation is a useful surgical step for addressing marked variability of the angle in variable angle esotropia and convergence excess esotropia.
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