Download fulltext HTML
1.
Rajavi Z, Feizi M, Aliasghar Nabavi S, Sabbaghi H, Behradfar N, Yaseri M, Faghihi M, Abdi S. Slanted versus Augmented Recession for Horizontal Strabismus. JOVR [Internet]. 2019Oct.24 [cited 2024Apr.25];14(4):465–473. Available from: https://knepublishing.com/index.php/JOVR/article/view/5453

https://doi.org/10.18502/jovr.v14i4.5453

statistics

  • 816 Abstract Views
  • 391 PDF Views
  • 0 HTML Views
  • Cited by 2 articles

authors

  • Zhale Rajavi

    Zhale Rajavi

    Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Torfeh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Negah Specialty Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Mohadeseh Feizi

    Mohadeseh Feizi

    Negah Specialty Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Sayed Aliasghar Nabavi

    Sayed Aliasghar Nabavi

    Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Hamideh Sabbaghi

    Hamideh Sabbaghi

    Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Narges Behradfar

    Narges Behradfar

    Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Mehdi Yaseri

    Mehdi Yaseri

    Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
  • Mohammad Faghihi

    Mohammad Faghihi

    Department of Ophthalmology, Torfeh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Saeid Abdi

    Saeid Abdi

    Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Published Date

  • Oct 24, 2019
This journal is publishing all the articles under Creative Commons Attribution License CC BY 4.0.

Slanted versus Augmented Recession for Horizontal Strabismus

Journal of Ophthalmic and Vision Research (JOVR) / October–December 2019, Volume 14, Issue 4 / Pages 465–473

Abstract

Purpose: To compare the surgical outcomes of slanted versus augmented recession in patients with horizontal strabismus.


Methods: In this randomized clinical trial, a total of 100 esotropic (ET) and exotropic (XT) patients with a high AC/A ratio which was defined as a difference of ≥ 10 prism diopters (pd) between the distance and near deviations were included if the patients had a distance deviation ≥ 15 pd. Patients were randomly assigned into the slanted (n = 26 in ET and n = 24 in XT group) and augmented recession groups (n = 25 in ET and n = 25 in XT group). In the slanted group, recession was performed on the superior and inferior poles of the muscle based on the distance and near deviations, respectively, while in the augmented recession group, the muscles were recessed 1.00 or 1.50 mm more than the standard amount according to the distance and near difference between 10 and 20 pd or > 20 pd, respectively.


Results: The mean age was 9.8 ± 9.6 years and 63% were female. There was a significant postoperative reduction of difference in convergence excess in ET cases compared to patients who underwent the augmented recession procedure (12.65 ± 6.16 vs 8.64 ± 6.1 pd, P = 0.014). Among our XT groups, there was no significant difference in postoperative reduction in the XT angle in the slanted group compared with the augmented group (P > 0.05).


Conclusion: Slanted recession is recommended in convergence excess ET patients. In XT patients, either slanted or augmented recession may be chosen according to the priority and experience of the surgeon.

Keywords:

Accommodative Convergence to Accommodation Ratio, Augmented Recession, Horizontal Strabismus, Slanted Recession

References
1. Chun BY, Kang KM. Early results of slanted recession of the lateral rectus muscle for intermittent exotropia with convergence insufficiency. J Ophthalmol 2015;2015:380467.

2. Bayramlar H, Ünlü C, Dag Y. Slanted medial rectus recession is effective in the treatment of convergence excess esotropia. J Pediatr Ophthalmol Strabismus 2014;51:337–340.

3. Griffin JR, Grisham JD. Binocular anomalies: diagnosis and vision therapy. 4th edition. Oxford, UK: USA, OEP Foundation, Butterworth-Heinemann; 2007:93.

4. Kushner BJ, Morton GV. Distance/near differences in intermittent exotropia. Arch Ophthalmol 1998;116:478–486.

5. Hatt S, Gnanaraj L. Interventions for intermittent exotropia. Cochrane Database Syst Rev 2006:CD003737.

6. Birnbaum MH, Soden R, Cohen AH. Efficacy of vision therapy for convergence insufficiency in an adult male population. J Am Optom Assoc 1999;70:225–232.

7. Akbari MR, Masoomian B, Jafari AK, Fard MA, Ameri A, Sadeghi AM. Slanted medial rectus recesection for treatment of exotropia with convergence insufficiency strabismus: a report of results in 15 cases. Binocul Vis Strabolog Q Simms Romano 2013;28:159–166.

8. Raab EL, Parks MM. Recession of the lateral recti effect of preoperative fusion and distance-near relationship. Arch Ophthalmol 1975;93:584–586.

9. Ellis GS Jr, Pritchard CH, Baham L, Babiuch A. Medial rectus surgery for convergence excess esotropia with an accommodative component: a comparison of augmented recession, slanted recession, and recession with posterior fixation. Am Orthopt J 2012;62:50–60.

10. Khalifa YM. Augmented medial rectus recession, medial rectus recession plus Faden, and slanted medial rectus recession for convergence excess esotropia. Eur J Ophthalmol 2011;21:119–124.

11. West CE, Repka MX. A comparison of surgical techniques for the treatment of acquired esotropia with increased accommodative convergence/accommodation ratio. J Pediatr Ophthalmol Strabismus 1994;31:232–237.

12. Yam JC, Wu P, Chong GS, Wong US, Chan CW, Ko ST. Long-term ocular alignment after bilateral lateral rectus recession in children with infantile and intermittent exotropia. J AAPOS 2012;16:274–279.

13. Rajavi Z, Lashgari A, Sabbaghi H, Behradfar N, Yaseri M. The incidence of reoperation and related risk factors among patients with infantile exotropia. J Pediatr Ophthalmol Strabismus 2017;54:22–30.

14. Kushner BJ. Strabismus: practical pearls you won’t find in textbooks. Springer International Publishing; 2017:79.

15. Parks MM. Extraocular muscles. In: Tasman W, Jaeger EA, editors. Duane’s clinical ophthalmology, revised edition, vol. 1. Philadelphia: Lippincott Williams & Wilkins, 1998;1–4.

16. Ahadzadegan I. Slanted recession of medial recti to treat convergence excess esotropia. Iran J Ophthalmol 2001;13:10–12.

17. Gharabaghi D, Zanjani LK. Comparison of results of medial rectus muscle recession using augmentation, Faden procedure, and slanted recession in the treatment of high accommodative convergence/accommodation ratio esotropia. J Pediatr Ophthalmol Strabismus 2006;43:91–94.

18. van der Meulen-Schot HM, van der Meulen SB, Simonsz HJ. Caudal or cranial partial tenotomy of the horizontal rectus muscles in A and V pattern strabismus. Br J Ophthalmol 2008;92:245–251.

19. Bietti GB. On a technical procedure (recession and fan-shaped oblique reinsertion of the horizontal rectusmuscles) for correction of V or A exotropias of slight degree in concomitant strabismus. Boll Ocul 1970;49:581–588. [Article in Italian]

20. Kushner BJ. Insertion slanting strabismus surgical procedures. Arch Ophthalmol 2011;129:1620–1625.

21. da Silva Costa RM, Kung J, Poukens V, Yoo L, Tychsen L, Demer JL. Intramuscular innervation of primate extraocular muscles: unique compartmentalization in horizontal recti. Invest Ophthalmol Vis Sci 2011;52:2830–2836.

22. Snir M, Axer-Siegel R, Shalev B, Sherf I, Yassur Y. Slanted lateral rectus recession for exotropia with convergence weakness. Ophthalmology 1999;106:992–996.

23. Yang HK, Hwang JM. Surgical outcomes in convergence insufficiency-type exotropia. Ophthalmology 2011;118:1512–1517.