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Four-muscle surgery for infantile esotropia with V-pattern
Summary
Bilateral medial rectus recession alone is more effective for infantile esotropia with V-pattern than combined horizontal and oblique muscle surgery. This approach significantly reduces esodeviation at distance and near without increasing the risk of A-pattern strabismus.
Area of Science:
- Ophthalmology
- Strabismus Surgery
- Pediatric Eye Care
Background:
- Inferior oblique overaction commonly co-occurs with infantile esotropia.
- V-pattern strabismus in conjunction with infantile esotropia may involve inferior oblique overaction.
- Surgical options include isolated horizontal muscle surgery or combined horizontal and oblique muscle procedures.
Purpose of the Study:
- To compare the efficacy of isolated medial rectus recession versus combined muscle surgery for infantile esotropia with V-pattern.
- To evaluate the impact on esodeviation reduction and the incidence of A-pattern strabismus.
Main Methods:
- A retrospective study comparing two surgical approaches for infantile esotropia with V-pattern.
- Group 1: Bilateral medial rectus recession (n=61).
- Group 2: Bilateral inferior oblique recession combined with bilateral medial rectus recession (n=18).
Main Results:
- Medial rectus recession alone resulted in a significantly greater reduction in esodeviation at distance (12.9 PD) and near (13.4 PD) compared to the 4-muscle surgery (P=0.03).
- The 4-muscle surgery group had a low incidence of postoperative A-pattern strabismus (11%).
Conclusions:
- Isolated bilateral medial rectus recession is a more effective surgical option for reducing esodeviation in patients with infantile esotropia and V-pattern.
- Combined muscle surgery may be considered when significant inferior oblique overaction is present, given the low risk of inducing A-pattern strabismus.