This prospective comparative study aims to compare medial rectus (MR) muscle fenestration and recession in patients with partially accommodative esotropia (PAET). The main question it aims to answer is whether MR fenestration is equally effective as MR recession for PAET. All patients will receive complete ophthalmic and orthoptic assessment. Patients will be randomly allocated using a random table to one of two groups; Group 1 will receive conventional MR recession, and Group 2 will receive MR fenestration.
Inclusion criteria The study will include patients with accommodative esotropia if the residual distance deviation with full cycloplegic correction is \> 15PD. Exclusion criteria: 1. Patients with convergence excess esotropia, defined as a near deviation with glasses exceeding that for distance by 15 PD or more. 2. Patients with paralytic or restrictive strabismus. 3. Patients with previous strabismus surgery 4. Patients with neurologic, ocular, or developmental disorders or follow-up less than 6 months All patients will receive complete ophthalmic and orthoptic assessment including: i) A full ophthalmological assessment including history taking, measurement of uncorrected and best-corrected visual acuity, cycloplegic refraction, anterior segment examination, as well as a dilated fundus examination. ii) Measurement of the deviation at distance (6 m) and near (33 cm). iii) Assessment of ductions and versions in all cardinal directions of gaze Patients will be randomly allocated using a random table to one of two groups: 1. Group 1: Unilateral or bilateral conventional MR recession. Augmented formula will be used to decide the Surgical dosage using the standard tables (3) 2. Group 2: unilateral or bilateral MR fenestration All surgeries will be performed by one experienced surgeon (H.SH)
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
60
Fenestration technique involves making two splitting incisions by blunt dissection parallel to the muscle fibers on the superior and inferior borders of the muscle, leaving 1 mm of muscle fibers on each edge. The rectangular wide central part is excised from the insertion and between the two splitting incisions to a point back 5-8 mm depending on the angle of the esotropia.
recession is one of the gold standard weakening procedures that involves disinsertion of the muscle and re-suturing to the sclera at a more posterior location to decrease its contractile power.
Tanta University
Tanta, Gharbia Governorate, Egypt
RECRUITINGOcular alignment (measured in prism diopters)
The distance and near angles of deviation, with and without glasses, and the angle disparity
Time frame: 6 months postoperative
ocular motility
ductions of both eyes (graded on a scale of nine points from -4 to +4)
Time frame: 6 months postoperative
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