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Unilateral Horizontal Rectus Muscle Recessions for Pediatric Comitant Strabismus
Kimberly S Merrill1, Raymond G Areaux1
1Department of Ophthalmology & Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota, USA.
Insights
Unilateral horizontal rectus muscle recession (UHR) successfully treated pediatric strabismus in 71.9% of cases. Unilateral lateral rectus recession for exotropia showed higher success rates, especially for smaller deviations.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Strabismus Surgery
Background:
- Bilateral horizontal rectus muscle recession (BHR) is a common strabismus surgery.
- Unilateral horizontal rectus muscle recession (UHR) offers potential benefits like reduced operating time and fewer complications.
Purpose of the Study:
- To evaluate the efficacy and outcomes of UHR in pediatric patients with comitant strabismus.
- To compare success rates for unilateral medial rectus recession (UMR) in esotropia (ET) and unilateral lateral rectus recession (ULR) in exotropia (XT).
Main Methods:
- Retrospective chart review of pediatric patients undergoing UMR for ET or ULR for XT.
- Success defined as post-operative distance deviation within specific ranges at 3 months.
- Analysis of postoperative horizontal incomitance (HI) and success rates based on recession size.
Main Results:
- Overall primary success rate for UHR was 71.9%.
- ULR for XT had a success rate of 80%, with higher success in small to medium deviations.
- UMR for ET had a success rate of 53.9%; success rates decreased for large recessions in both ET and XT.
Conclusions:
- UHR is a viable surgical option for pediatric comitant strabismus, with ULR for XT being particularly effective.
- Large UMR and ULR may have lower success rates and can lead to postoperative incomitance, though often not clinically significant.
Introduction:
Compared to bilateral horizontal rectus muscle recessions (BHR), a unilateral horizontal rectus muscle recession (UHR) confers shorter operating time and anesthesia exposure, limits complication risks to one eye, and requires less recovery from the patient.
Methods:
Retrospective chart review of pediatric patients who underwent unilateral medial rectus recession (UMR) for esotropia (ET), or unilateral lateral rectus recession (ULR) for exotropia (XT). Primary successes were defined as maximum distance deviation at post-operative month 3: -12 to +5 for ET, -5 to +12 for XT. Rates of postoperative horizontal incomitance (HI) >5 PD and success for small medium, and large (in mm, respectively, ET: <5, 5-6 mm, >6; XT: <8, 8-10, >10) recessions were analyzed.
Results:
Seventeen ETs and 40 XTs were analyzed. Overall primary success was 71.9% (p = .02). Significantly, 80% (95% CI: 67.60,92.40) XTs succeeded. ETs were equally likely to succeed (53.9%) or fail (47.1%) (p = .22). For patients without significant preoperative HI, average postoperative HI was 3.90 PD (95% CI: 0.20, 7.60) for ETs; 5.48 PD (95% CI: 3.65, 7.32) for XTs.
Conclusions:
UHR was 71.9% successful in treating pediatric comitant strabismus. ULR for XT, particularly small to medium deviations, was most likely to succeed. In contrast to prior reports, large UMR and ULR were less likely to succeed and post-operative incomitance was frequent but rarely clinically significant.
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