Comparison of the results of the modified and classical bi-medial hang-back recession in infantile esotropia.

PURPOSE: Bi-medial rectus recession, which can also be performed using a hang-back technique, is one of the surgical treatment options for infantile esotropia (IE). This study has modified the surgical approach, with outcomes compared to the traditional hang-back technique. METHODS: The bi-medial recession was performed with a modified hang-back technique in 120 IE patients and with a traditional hang-back technique in 88 cases. Surgical outcomes were reviewed and compared retrospectively. RESULTS: The patients in the two groups were compared in terms of surgery time, inferior oblique weakening surgery, and the presence of refractive error. The differences between pre-operative and postoperative first-month, sixth-month, and first-year degrees were statistically significant (p < 0.001). CONCLUSIONS: This modified novel technique aims to avoid unwanted muscle movement in the horizontal and vertical axes and a gap in the middle of the recessed muscle, as seen in the traditional hang-back technique. Further, the modified technique resulted in less over- and under-correction as well as alphabetic pattern deviation.

Isolated medial rectus muscle laceration after bird strike.

INTRODUCTION: A 66 year-old male suffered globe trauma due to A bird, a German Desert Hawk, strike. At the first examination in the emergency ünit a few hours after the injury, the patient reported persistent horizontal diplopia. CASE REPORT: He had right conjunctival laceration, mild proptosis, subconjunctival hematoma, exotropia with no adduction. Magnetic Resonance Imaging (MRI) revealed that it was suggestive of laceration of the right medial rectus muscle, at about the junction of it's anterior and middle thirds. During surgery; initially, the lacerated proximal end of the distal segment was isolated. The proximal segment of the medial rectus muscle was then carefully dissected. The two lacerated ends were then joined with 6-0 polyglactin sutures. CONCLUSION: The day after surgery, there was no deviation and diplopia in all diagnostic gaze positions.

Disinsertion-distal myectomy and tucking of inferior oblique combined with superior oblique full tendon advancement in superior oblique palsy.

PURPOSE: To assess the preliminary outcomes of inferior oblique (IO) disinsertion-distal myectomy and tucking combined with superior oblique (SO) full tendon advancement in patients with Knapp II or III superior oblique palsy. METHODS: This single-centered retrospective study included 16 eyes from 13 patients with Knapp Class II or III SO palsy. All patients underwent IO disinsertion-distal myectomy and tucking combined with SO full tendon advancement while under general anesthesia. Pre- and post-operative levels of vertical deviation in the primary position, abnormal head position, IO hyperfunction and SO hypofunction, torsion, as well as the presence of diplopia, were all measured, and the differences were statistically compared. RESULTS: Pre-operatively, 12 patients had abnormal head positions, and two had diplopia. The pre-and post-operative levels of IO hyperfunction and SO hypofunction, as well as a vertical deviation in the primary position and torsion, all differed statistically significantly (p < 0.01). CONCLUSIONS: Inferior oblique disinsertion distal myectomy and tucking combined with SO full tendon advancement surgery appears to be an effective procedure in patients with congenital and acquired Knapp Class II or III SO palsy.