Advertisement

Wright hang-back recession with fibrin glue compared with standard fixed suture recession for the treatment of horizontal strabismus

Published:December 22, 2020DOI:https://doi.org/10.1016/j.jcjo.2020.11.012

      Abstract

      Objective

      To evaluate the clinical safety and efficacy of the novel Wright hang-back recession with fibrin glue for the treatment of horizontal strabismus.

      Study Design

      Retrospective, case-controlled clinical study comparing surgical outcomes of the Wright hang-back rectus recession with fibrin glue (WHBG) versus standard fixed suture rectus recession (SFR).

      Methods

      Medical records of all patients who underwent strabismus surgery by one strabismus surgeon between 2016 and 2018 for horizontal deviations only, including cases of WHBG (group 1) or SFR (group 2), were reviewed. Good surgical outcome was defined as a postoperative deviation ≤10 prism diopters (PD) at a minimum 2 months of follow-up.

      Results

      32 eyes of 17 patients underwent WHBG and 32 eyes of 17 patients underwent SFR; in each group, 35% had esotropia and 65% had exotropia. Mean preoperative deviations between groups were similar: esotropia 25.5 PD and exotropia 26.6 PD in WHBG; esotropia 28.3 PD and exotropia 23.8 PD in SFR. The mean postoperative deviation was <7 PD for both groups. Good surgical outcomes were similar between groups, 16/17 (94%) in WHBG and 15/17 (88%) in SFR, with no complications.

      Conclusions

      WHBG was safe and effective with postoperative results similar to SFR. WHBG has an important advantage, eliminating the complication of retinal perforation that can occur with SFR while avoiding under- or overcorrection that can occur with traditional hang-back recession. This technique increases patient safety without sacrificing surgical outcomes and is especially useful in patients with thin sclera such as patients with high myopia or with difficult posterior exposure.

      Objectif

      Évaluer l'innocuité et l'efficacité cliniques d'une technique nouvelle, soit le recul sur anse (hang-back recession) de Wright avec colle à la fibrine, dans le traitement du strabisme horizontal.

      Nature

      Étude clinique cas-témoins rétrospective comparant les résultats chirurgicaux de la récession du muscle droit réalisée par recul sur anse de Wright avec colle à la fibrine (RAWC) et ceux de la récession du muscle droit avec suture fixe standard (SFS).

      Méthodes

      Les dossiers médicaux de tous les patients qui ont subi une correction chirurgicale du strabisme (déviations horizontales seulement) aux mains d'un seul chirurgien spécialisé entre 2016 et 2018 ont été passés en revue, et les patients ont été répartis en 2 groupes : RAWC (groupe 1) et SFS (groupe 2). On a défini l'obtention de bons résultats chirurgicaux comme suit : déviation postopératoire ≤ 10 dioptries prismatiques (DP) après un suivi d'au moins 2 mois.

      Résultats

      Ainsi, 32 yeux de 17 patients ont subi un RAWC et 32 yeux de 17 patients ont subi une SFS; dans chaque groupe, 35 % des sujets présentaient une ésotropie, et 65 %, une exotropie. Les déviations préopératoires moyennes étaient semblables dans les 2 groupes : ésotropie de 25,5 DP et exotropie de 26,6 DP dans le groupe RAWC; ésotropie de 28,3 DP et exotropie de 23,8 DP dans le groupe SFS. La déviation postopératoire moyenne se chiffrait à < 7 DP dans les 2 groupes. On a obtenu de bons résultats chirurgicaux, et ces derniers étaient comparables dans les 2 groupes : 16/17 (94 %) dans le groupe RAWC et 15/17 (88 %) dans le groupe SFS. On ne signale aucune complication.

      Conclusions

      Le RAWC est sûr et efficace et donne des résultats postopératoires semblables à ceux de la SFS. Le RAWC offre toutefois un avantage important : il élimine le risque de perforation de la rétine, qui peut survenir pendant la SFS, sans entraîner la sur- ou la sous-correction que peut engendrer le recul sur anse classique. Cette nouvelle technique, qui accroît l'innocuité sans nuire aux résultats chirurgicaux, est particulièrement utile en présence d'une sclère mince, notamment dans la forte myopie ou devant une exposition postérieure difficile.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Canadian Journal of Ophthalmology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Simon JW
        • Lininger LL
        • Scheraga JL.
        Recognized scleral perforation during eye muscle surgery: incidence and sequelae.
        J Pediatric Ophthalmol Strabismus. 1992; 29: 273-275
        • Wan JM
        • Hunter DG.
        Complications of strabismus surgery: incidence and risk factors.
        Semin Ophthalmol. 2014; 29: 421-428
        • Bradbury JA
        • Taylor RH.
        Severe complications of strabismus surgery.
        J AAPOS. 2013; 17: 59-63
        • Rathod D
        • Goyal R
        • Watts P.
        A survey of the management of globe perforation during strabismus surgery in the United Kingdom.
        Strabismus. 2011; 19: 63-66
        • Chung AK
        • Rehman SU
        • Bradbury JA.
        Comparison of modified anchored hang-back technique (HBT) with conventional HBT in bimedial rectus recession.
        J AAPOS. 2005; 9: 234-239
        • Hemmerdinger C
        • Rowe N
        • Baker L
        • Lloyd IC.
        Bimedial hang-back recession-outcomes and surgical response.
        Eye. 2005; 19: 1178-1181
        • Rajavi Z
        • Ghadim HM
        • Nikkhoo M
        • Dehsarvi B.
        Comparison of hang-back and conventional recession surgery for horizontal strabismus.
        J Pediatr Ophthalmol Strabismus. 2001; 38: 273-277
        • Markland DS.
        Study to assess the value of Dacron sling.
        Br J Ophthalmol. 1986; 70: 623-629
        • Hertle RW
        • Gole GA
        • Quinn GE.
        Reinsertion site remodeling after suspension-and conventional recession of extraocular muscles: an initial study in rabbits.
        Binocular Vis Q. 1991; 6: 227-235
        • Roh YB
        • Nam H
        • Qum BS.
        The study of anatomical attachment of the extraocular muscle following recession with hang-loose technique in rabbits.
        J Korean Ophthalmol Soc. 1991; 32: 688-693
        • Repka MX
        • Fishman PG
        • Guyton DL.
        The site of reattachment of the extraocular muscle following hang-back recession.
        J Pediatr Ophthalmol Strabismus. 1990; 27: 286-290
        • Ohtsuki H
        • Oshima K
        • Hasebe S
        • et al.
        Extraocular muscle surgery in a rabbit model: site of reattachment following hang-back and conventional recession.
        Graefes Arch Clin Exp Ophthalmol. 1994; 232: 689-694
        • Park J
        • Lee JJ
        • Lim EH
        • Lee JH
        • Jin KH
        • Kim US.
        Effect of fibrin glue as an adjuvant to hang-back surgery.
        BMC Ophthalmol. 2012; 12: 14-19
        • Ameri A
        • Jafari AK
        • Anvari F
        • Ahadzadeghan I
        • Rajabi MT.
        A new modified anchored suspension-recession (so-called “Hang-back”) technique for high risk strabismus surgery.
        Binocul Vis Strabismus Q. 2010; 25: 21-30
        • Anton O
        • Monte M
        • Gui-Shang Y
        • Chengcheng L
        A comparison of hang-back with conventional recession surgery for exotropia.
        J AAPOS. 2007; 11: 597-600
        • Capo H
        • Repka MX
        • Guyton DL.
        Hang-back lateral rectus recessions for exotropia.
        J Pediatr Ophthalmol Strabismus. 1989; 26: 31-34
        • Awadein A
        • Marsh JD
        • Guyton DL.
        Nonabsorbable versus absorbable sutures in large, hang-back medial rectus muscle recessions.
        J AAPOS. 2016; 20: 206-209
        • Potter WS
        • Nelson LB
        • Handa JT.
        Hemihang-back recession: description of the technique and review of the literature.
        Ophthalmic Surg. 1990; 21: 711-715
        • Wong K
        • Goldstraw P.
        Effect of fibrin glue in the reduction of postthoracotomy alveolar air leak.
        Ann Thorac Surg. 1997; 64: 979-981
        • Sawamura Y
        • Asaoka K
        • Terasaka S
        • Tada M
        • Uchida T.
        Evaluation of application techniques of fibrin sealant to prevent cerebrospinal fluid leakage: a new device for the application of aerosolized fibrin glue.
        Neurosurgery. 1999; 44: 332-337
        • Erbil H
        • Sinav S
        • Sullu Y
        • Kandemir B.
        An experimental study on the use of fibrin sealants in strabismus surgery.
        Turk J Pediatr. 1991; 33: 111-116
        • Tonelli E
        • Almeida HC
        • Bambirra EA.
        Tissue adhesives for a sutureless fadenoperation: an experimental study in a rabbit model.
        Invest Ophthalmol Vis Sci. 2004; 45: 4340-4345
        • Spierer A
        • Baraquet I
        • Rosner M
        • et al.
        Reattachment of extraocular muscles using fibrin glue in a rabbit model.
        Invest Ophthalmol Vis Sci. 1997; 38: 543-546
        • Eustis HS
        • Rhodes A.
        Suture contamination in strabismus surgery.
        J Pediatr Ophthalmol Strabismus. 2012; 49: 206-209
        • Wright KW
        • Strube YJ.
        Color Atlas of Strabismus Surgery: Strategies and Techniques.
        4th ed. Springer, Philadelphia, PA2015: 79
        • Topiwala P
        • Bansal RK.
        Comparative evaluation of cyanoacrylate and fibrin glue for muscle recession in strabismus surgery.
        J Pediatr Ophthalmol Strabismus. 2014; 51: 349-354
        • Wright KW
        • Corradetti G
        • Strube YJ
        • Mai SV.
        Foreign body extrusion associated with N-butyl-2-cyanoacrylate glue used with rectus muscle hang-back recession.
        Can J Ophthalmol. 2020; 55: 58-62