Over-correction Rate between Wright Hang-Back Glue Recession versus Standard Fixed Suture Recession for Esotropia

Theme: Paediatric ophthalmology and strabismus
What: Paediatric ophthalmology and strabismus
Part of: Paediatrics II: Strabismus- Innovations and Challenging Cases / Pédiatrie II: Ophtalmologie pédiatrique et strabisme - Dépistage du rétinoblastome
When: 6/2/2024, 11:15 AM - 12:45 PM
Where: Room | Salle 714 A

Abstract

Purpose: To compare the risk of over-correction after medial rectus (MR) recession with the Wright hang-back glue versus standard fixed suture techniques. Guyton and Chung have reported standard hang-back recession has an over correction rate of 20% to 30%  potentially due to poor muscle-sclera adherence.  Hang-back recession reduces the complication of retinal tear, but the muscle may not adhere at the desired position increasing the risk of late posterior slippage and over-correction.

Study Design: Retrospective chart review of patients with MR recession by two techniques (Wright hang-back rectus recession with fibrin glue (WHBG) versus standard fixed suture rectus recession (SFR)) to treat esotropia. Historical comparison to results of standard hang-back recession of medial rectus muscle by literature review.  

Methods: Medical records of 166 patients who underwent strabismus surgery by one surgeon between ­­­2017-2022 were reviewed. Inclusion criteria were patients who underwent MR recession by WHBG or SFR to correct esotropia. Exclusion criteria were patients undergoing concurrent strabismus surgery for vertical deviation, and patients without long-term follow-up. Primary outcome measure was incidence of over correction post-operatively defined as > 10 PD with minimum 3 months follow-up. Secondary outcome measure was post-operative alignment: good surgical outcome defined as post-operative deviation < or equal to 10 PD with minimum 3 months follow-up. Tertiary outcome was post-operative complications and rate of resolved diplopia. Data was analyzed using t-tests for continuous data, Fisher’s exact test for non-continuous data (SPSS). Study was approved by our institutional Health Sciences Research Ethics Board. 

Results: 27 eyes (14 patients) underwent WHBG and 58 eyes (32 patients) underwent SFR of the MR. Demographics were similar/non-significantly different between groups. Patients ranged from 6 months - 71 years. Pre-operative mean esotropia was 31.2+/- 10 PD (WHBG) and 32.3+/- 16PD (SFR); average MR recession 5.5+/- 1 mm (SFR) and 5.3+/- 0.7 mm (WHBG). Post-operative over-correction at 3-12 months was similar between groups: 0/13 (0%) (WHBG) and 1/29 (3.5%) (SFR) (p=1.00). Good surgical outcomes at 3-12 months post-operatively were similar between groups, 13/13 (100%) (WHBG) and 27/29 (93.1%) (SFR) (p=1.00), average post-operative deviation was 2.5+/- 2.6PD (WHBG) and 2.2+/- 7.7PD (SFR) (p=0.85). No complications occurred in either group. Diplopia resolved in 5/7 (62.5%) (WHBG) and 5/8 (71.4%) (SFR) patients (p=1.0).

Conclusions: WHBG recession of the medial rectus muscle was effective, with post-operative results not significantly different than SFR.  WHBG has the important advantage of eliminating the complication of retinal perforation that can occur with SFR whilst avoiding over-correction that can occur with traditional hang-back recession.

Presenter(s)

Presenting Author: Yi Ning Strube

Additional Author(s):

Bella Germano, California Institute of Technology

Ralph Zein, Emory University

Wilma Hopman, Kingston Health Sciences Centre

Kenneth Wright, Wright Foundation for Pediatric Ophthalmology and Strabismus; Queen's University

---