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.
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Article info
Publication history
Published online: December 22, 2020
Accepted:
November 23,
2020
Received in revised form:
October 12,
2020
Received:
June 1,
2020
Footnotes
Institution where study conducted: Wright Foundation for Pediatric Ophthalmology and Strabismus, Los Angeles, CA.
Preliminary data from this paper have been previously presented as a paper presentation at the 155th Annual Meeting, American Ophthalmological Society, The Greenbriar, White Sulphur Springs, WV, May 19, 2019, and have been presented as an ePoster at the American Academy of Ophthalmology (AAO) 2019 Annual Meeting. The final data from this paper were also presented as a paper at the 2020 Canadian Ophthalmological Society (COS) Annual Meeting virtual Pediatric Ophthalmology and Strabismus session, June 27, 2020.
Identification
Copyright
© 2020 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
