Treatment of partially accommodative esotropia in children using a medial rectus muscle fenestration technique

Abstract

To report the results of bilateral fenestration of the medial rectus muscle in cases of partially accommodative esotropia in pediatric patients. In this fenestration technique, two splitting incisions are made by blunt dissection parallel to the muscle fibers on the superior and inferior borders of the medial rectus muscle, leaving a thin strip of muscle fibers on each edge. The wide, central part of the muscle is excised from its insertion to a point 5-8 mm from the insertion, depending on the angle of the esotropia. Sutures are not used in this procedure. Children with partially accommodative esotropia and no high ratio of accommodative convergence to accommodation who underwent surgery from February 2018 to August 2019 were prospectively enrolled. The success rate was defined as alignment within 8 prism diopters of orthotropia at the last follow up. A total of 61 children were included. The procedure was well tolerated by patients and reduced the angle of esotropia for distance from 22.20Δ ± 4.22Δ to 2.72Δ ± 4.71Δ (P<0.001) and caused no incomitance or distance-near disparity. Satisfactory horizontal alignment defined as alignment within 8Δ of orthotropia at distance was achieved in 88% of the cases at 3-6 months' follow-up. There were no overcorrections. In our study cohort, the fenestration technique reduced the angle of deviation in cases of partially accommodative esotropia.