Surgical management of Esotropia Flashcards
(22 cards)
What are the surgical approaches for constant and intermittent strabismus?
Constant and intermittent strabismus can be managed through:
* MR Recession / LR Resection
* Bimedial Rectus Recessions
* Combination of both (3 or 4 muscle surgery)
* Single Muscle Recession / Resection
* Recess / resect
What is the action of the medial rectus muscle?
The medial rectus muscle has the greatest action at near
What is the action of the lateral rectus muscle?
The lateral rectus muscle has the greatest action at distance
What is MR Recession?
MR Recession is a procedure that moves the muscle insertion posteriorly to weaken its action
What is LR Resection?
LR Resection is a procedure that cuts the muscle by making it shorter to strengthen its action
In cases of esotropia, what are the choices for surgical correction?
Choices include:
* MR Recession / LR Resection
* Bimedial Rectus Recessions
* Combination of both (3 or 4 muscle surgery)
* Single Muscle
What is the perceived risk level of bimedial recessions?
Bimedial recessions are perceived to have less risk than recess / resect
What is the success rate for esotropia with <70∆ using 2 muscle operations?
68% success rate for esotropia
What is the success rate for esotropia with ≥70∆ using 3 muscle operations?
67% success rate for 3 muscle surgery vs 40% success for 2 muscle surgery
What factors contribute to poorer surgical outcomes in esotropia?
Factors include:
* Presence of amblyopia
* Older age
What is the aim of surgery in constant esotropia?
Aims include:
* Improve ocular alignment
* Make deviation less noticeable
* Slightly under-correct angle by approximately 10Δ BO
What is the recommended timing for surgery in esotropia without an accommodative element?
Onset <30 months is unlikely to develop stereopsis; onset >44 months with no amblyopia is more likely to develop good stereoacuity
What is the surgical principle for constant esotropia?
Unilateral MR recession/LR resection if deviation is approximately equal near & distance; bilateral MR recession for greater near deviation
What is the relationship between age and timing of surgery in esotropia?
Younger patients (<30 months) are less likely to develop stereoacuity; older onset (>44 months) without amblyopia is more favorable
What is the significance of the studies by Sturm et al. on acute acquired concomitant esotropia?
92% achieved successful alignment with one surgical procedure; 84% achieved some stereopsis postoperatively
What are the findings regarding early vs late-onset accommodative esotropia?
No amblyopia developed in early-onset group; higher incidence of amblyopia in late-onset group
What is the treatment for convergence excess esotropia?
Bilateral medial rectus recession possibly with Faden procedure; unilateral surgery may involve recessing MR and resecting LR
What is the purpose of posterior fixation suture (Faden)?
To limit the action of the muscle or make the muscle work harder while producing minimal effect in primary position
What are the surgical options for distance esotropia?
Options include:
* Bilateral LR resections
* Asymmetrical LR resect/MR recess
* Unilateral LR resect/MR recess if large near angle
What is the average age of patients undergoing single muscle lateral rectus resection for distance esotropia?
Average age is 79.8 years
What is cyclic esotropia?
A condition that may require surgical correction to fully correct the manifest angle of deviation
What is recommended regarding surgery timing for cyclic esotropia?
Surgery should be performed while the esotropia is cyclic to reduce the risk of recurrence
