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Augmented bimedial rectus muscles recession in acute acquired concomitant esotropia associated with myopia

Published:November 05, 2020DOI:https://doi.org/10.1016/j.jcjo.2020.10.006

      Abstract

      Objective

      To review the clinical features of acute acquired concomitant esotropia in myopia and the results of augmented bilateral symmetrical medial rectus recession.

      Methods

      The medical charts of 50 patients diagnosed with acute acquired concomitant esotropia associated with myopia between 2013 and 2018 were reviewed. The dose-response was calculated, and the relationship of sex, age, refraction, best-corrected visual acuity (BCVA), preoperative deviation angle, and stereopsis with surgical results were analysed.

      Results

      Forty-six patients (mean age 40.1 ± 18.1 years) were included in the study. Preoperative esotropia angle at near and distance were, respectively, 26.0 ± 7.5 PD and 25.2 ± 7.9 PD. Surgery amount was 12.1 ± 1.8 mm of recession, and surgical success was achieved in 38 patients (82.6%). No overcorrections were recorded. At 1-year follow-up, the mean deviation angle at distance and at near was 1.9 ± 2.4 and 1.7 ± 2.1 PD, and no recurrences were observed. The average dose-response was 1.8 ± 0.6 PD/mm and was positively correlated with preoperative angle of deviation (R2 = 0.799, p < 0.001) and negatively correlated with age (R2 = −0.365, p = 0.013). Conversely, there were no significant associations between dose-response and sex, refractive error, BCVA, or stereopsis (all p > 0.05). Factors associated with surgical failure were a lower amount of recession and absence of stereopsis.

      Conclusions

      Augmented bilateral medial rectus recession allows good motor and sensory results in patients with acute acquired concomitant esotropia associated with myopia.

      Objectif

      Examiner les caractéristiques cliniques de l’ésotropie concomitante acquise aiguë associée à la myopie et les effets de la récession symétrique bilatérale augmentée du droit médial.

      Méthodes

      Ont été passés en revue les dossiers médicaux de 50 patients qui avaient reçu un diagnostic d’ésotropie concomitante acquise aiguë associée à la myopie entre 2013 et 2018. On a calculé la dose-réponse et analysé le lien entre le sexe, l’âge, la réfraction, la meilleure acuité visuelle corrigée (MAVC), l'angle de déviation préopératoire et la vision stéréoscopique, d'une part, et les résultats chirurgicaux, d'autre part.

      Résultats

      L’étude regroupait 46 patients (âge moyen : 40,1 ± 18,1 ans). L'angle d’ésotropie préopératoire en vision de près et en vision de loin se chiffrait à 26,0 ± 7,5 PD et à 25,2 ± 7,9 PD, respectivement. La récession a été de 12,1 ± 1,8 mm, et l'intervention a été une réussite chez 38 patients (82,6 %). Il ne s'est produit aucune surcorrection. Au moment du suivi à 1 an, l'angle de déviation moyen en vision de loin et en vision de près s’élevait à 1,9 ± 2,4 PD et à 1,7 ± 2,1 PD, et aucune récidive ne s’était produite. La dose-réponse moyenne, soit 1,8 ± 0,6 PD/mm, était en corrélation positive avec l'angle de déviation préopératoire (R2 = 0,799; p < 0,001) et en corrélation négative avec l’âge (R2 = −0,365; p = 0,013). En revanche, on n'a noté aucune association significative entre la dose-réponse et le sexe, l'erreur de réfraction, la MAVC ou la vision stéréoscopique (p > 0,05 pour l'ensemble des mesures). Parmi les facteurs associés à l’échec de la chirurgie, citons une récession moindre et l'absence de vision stéréoscopique.

      Conclusions

      La récession bilatérale augmentée du droit médial donne de bons résultats moteurs et sensitifs chez des patients qui présentent une ésotropie concomitante acquise aiguë associée à la myopie.
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