Comparative Study of Y-Split Recession versus Faden Technique for Management of Infantile Esotropia in Egyptians

Journal of Ophthalmology, Aug 2018

Purpose. This study compares the results of Y-split recession versus de Decker’s (modified Cüppers) Faden techniques of medial rectus (MR) muscles for the management of essential infantile esotropia (IET). Patients and Methods. Fifty patients had IET divided into Group A who underwent Y-split recession of MR muscles and Group B who underwent de Decker’s Faden technique of MR muscles. All patients had complete ophthalmic examination done including deviation angle measurement and met the inclusion criteria of the study. Operations were performed using general anesthesia. Patients were followed up at day 1, week 1, and months 1, 3, and 6 after operation. Results. The mean age distribution for group A was 21.56 months (SD 12.55) and for group B was 21.4 months (SD 12.35), and the mean postoperative follow-up interval was 6 months for both groups. The preoperative maximum angle of deviation in both groups ranged from 15 to 40 degrees, while the minimum angle of deviation ranged from 10 to 20 degrees. Immediately postoperatively both groups showed 88% of patients with satisfactory results (within 10 degrees of orthotropia). Group A showed two patients (8%) with ET and one patient (4%) with exotropia (XT). For group B, it showed one patient (4%) with ET and two patients (8%) with XT. Three patients in each group underwent a second intervention. All patients remained within the satisfactory range. Conclusion. The results of this study suggest that both techniques show comparable results for the correction of IET.

A PDF file should load here. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a PDF plug-in installed and enabled in your browser.

Alternatively, you can download the file locally and open with any standalone PDF reader:

http://downloads.hindawi.com/journals/joph/2018/3408614.pdf

Comparative Study of Y-Split Recession versus Faden Technique for Management of Infantile Esotropia in Egyptians

Comparative Study of Y-Split Recession versus Faden Technique for Management of Infantile Esotropia in Egyptians Nermeen Badawi1 and Ahmed Taha Ismail2 1Ophthalmology Department, Faculty of Medicine, Menoufiya University, Shebin El-Kom, Menoufiya, Egypt 2Ophthalmology Department, Faculty of Medicine, Ain-Shams University, Abbaseya, Cairo, Egypt Correspondence should be addressed to Ahmed Taha Ismail; moc.oohay@ahat_damhard Received 7 April 2018; Accepted 12 July 2018; Published 1 August 2018 Academic Editor: Alejandro Cerviño Copyright © 2018 Nermeen Badawi and Ahmed Taha Ismail. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Purpose. This study compares the results of Y-split recession versus de Decker’s (modified Cüppers) Faden techniques of medial rectus (MR) muscles for the management of essential infantile esotropia (IET). Patients and Methods. Fifty patients had IET divided into Group A who underwent Y-split recession of MR muscles and Group B who underwent de Decker’s Faden technique of MR muscles. All patients had complete ophthalmic examination done including deviation angle measurement and met the inclusion criteria of the study. Operations were performed using general anesthesia. Patients were followed up at day 1, week 1, and months 1, 3, and 6 after operation. Results. The mean age distribution for group A was 21.56 months (SD 12.55) and for group B was 21.4 months (SD 12.35), and the mean postoperative follow-up interval was 6 months for both groups. The preoperative maximum angle of deviation in both groups ranged from 15 to 40 degrees, while the minimum angle of deviation ranged from 10 to 20 degrees. Immediately postoperatively both groups showed 88% of patients with satisfactory results (within 10 degrees of orthotropia). Group A showed two patients (8%) with ET and one patient (4%) with exotropia (XT). For group B, it showed one patient (4%) with ET and two patients (8%) with XT. Three patients in each group underwent a second intervention. All patients remained within the satisfactory range. Conclusion. The results of this study suggest that both techniques show comparable results for the correction of IET. 1. Introduction Infantile esotropia can be managed by minimizing torque (T) of medial rectus (MR) muscles. T = F ∗ r [1], where F represents the force exerted by MR and r represents the lever arm. T can be reduced by minimizing F or r [1–6]. Techniques for r reduction include Faden operation, a concept introduced by Cüppers [7–11], which decreases MR r by suturing it to back of the globe. Many studies showed that this controls strabismus [12–14]. Y-split recession mostly involves MR splitting and resuturing thus reducing MR r and effective muscle F [15–19]. It is a concept introduced by Priglinger 1990 and published 1994. Long-term studies and statistical analysis of the outcome after surgical therapy were followed by Haslwanter et al. [18] and Hoerantner et al. [19]. This study aims at comparing both techniques of IET. 2. Patients and Methods The fifty patients involved in this study with big-angle infantile ET were divided into Group A (Y-split recession of MR) and Group B (de Decker’s Faden technique who, in contrary to Cüppers, preferred to leave the muscle in place and secure it with a triple loop to prevent its sliding through the suture). All patients were subjected to complete ophthalmic examination and met the inclusion criteria, which were (1) ET diagnosed by an ophthalmologist before the age of sixth months, (2) absence of fixation preference, and (3) ET maximum angle values varying from 15 to 40 degrees and were determined using Hirschberg, Krimsky, or prism alternate cover test for distance and near (whenever possible with proper conversion) with optimal refractive correction (whenever needed). Due to variability of strabismus angles, maximum and minimum (static) angles as well as the difference between both (dynamic) were measured at each distance three times, and the average was taken for each distance. Exclusion criteria were neurological abnormalities, developmental delays, nystagmus, anomalous head posture (AHP), convergence excess, or ocular structural abnormalities. Cycloplegic refraction was performed, and glasses were used in patients with hyperopia of +3.0 diopter (D) or more for at least one month to exclude any accommodative component. Duction and version movements, oblique muscle overaction, pattern (V or A), and dissociated strabismus were recorded. All operations were performed under general anesthesia using the operating microscope. Follow-up visits were conducted at 1 day; 1 week; and 1, 3, and 6 months postoperatively. Fixation assessment in young children and “illiterate E game” and Snellen acuity chart testing were performed in elderly children for vision assessment. (...truncated)


This is a preview of a remote PDF: http://downloads.hindawi.com/journals/joph/2018/3408614.pdf

Nermeen Badawi, Ahmed Taha Ismail. Comparative Study of Y-Split Recession versus Faden Technique for Management of Infantile Esotropia in Egyptians, Journal of Ophthalmology, 2018, 2018, DOI: 10.1155/2018/3408614