Evaluation of The Techniques of Lateral Rectus Muscle Combined Recession With Hang Back and Combined Recession With Z-Tenotomy in Correcting Large-Angle Exotropia
试验速览
- 阶段
- 不适用
- 状态
- 尚未招募
- 入组人数
- 50
- 主要终点
- sucessful alignment
研究概览
简要总结
The aim of this study is to evaluate the techniques of combined lateral rectus muscle recession with hang back and combined lateral rectus muscle recession with z-tenotomy in correcting large-angle exotropia.
详细描述
Strabismus was defined as any heterotropia at near or distance fixation, or both, on cover testing. Micro strabismus was known as a deviation of fewer than 10 prism diopters (PD). Different studies have defined large angle deviation as 35 Δ , 40 Δ, 50 Δ and 60 Δ.
Studies revealed that during the first decade of life, exotropia is most prevalent with intermittent exotropia and convergence insufficiency are the most frequent. Exotropic deviations include exophoria, infantile exotropia, intermittent exotropia, sensory exotropia and consecutive exotropia.
Large-angle constant exotropia has a negative impact on the patients and surgical treatment of exodeviations improves the patient's psychosocial functioning. Hence, many surgical techniques have been described for management of exotropia, including bilateral lateral rectus recessions or recess/resect procedures. Botulinum toxin injection combined with recession-resection procedures was used as another surgical technique.
As a fact large-angle exotropia usually requires greater amounts of surgery, often a surgery on a greater number of extraocular muscles. Hence, 3 or 4 horizontal muscle surgery was performed for correcting large angle exotropia. Single-staged three horizontal muscles surgery for large angle intermittent exotropia has been more successful.
Recently, medial rectus muscle surgery as bilateral medial rectus resection for primary large-angle exotropia has been used with successful results. A successful outcome of surgery was defined as deviation within 10 prism diopters for both distance and near.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patients suffering from large angle exotropia; defined, in this study, as an angle of deviation ≥ 40 prism diopters (PD).
排除标准
- •Patients suffering from exotropia with angle < 40 prism diopters (PD).
- •Patient with paralytic strabismus.
- •Patient with restrictive strabismus.
- •Patient with combined vertical and horizontal deviation.
- •Patients with previous strabismus surgery.
- •Patients who had previously been administered botulinum toxin A.
- •Patient refusal.
研究组 & 干预措施
combined lateral rectus muscle recession 7mm and Z- tenotomy technique.
The technique of lateral rectus muscle Z-tenotomy:
A. The muscle is exposed in the usual manner and two hemostats are each placed 80% of the way across the muscle (or tendon) from opposite borders. The hemostats are placed 3 or 4 mm apart.
B. The posterior hemostat is removed, and scissors are used to cut across the muscle in the crushed area. By cutting the muscle in the crushed area, bleeding is kept to a minimum.
C. The hemostat nearer the insertion is removed, and the muscle is cut along the crushed area using small snips with scissors.
D. lengthening of the muscle will occur. Any bleeding is controlled with pressure.
E. After the distal myotomy has been performed, in a very tight muscle, a No. 15 Bard Parker blade can be used to divide the tendon fibers, cutting against the muscle hook. This can be accomplished with a scraping motion with the knife blade at nearly right angles to avoid scleral perforation.
干预措施: Evaluation of The Techniques of Lateral Rectus Muscle Combined Recession with Hang Back and Combined Recession with Z-Tenotomy in Correcting Large-Angle Exotropia (Procedure)
combined lateral rectus muscle recession 7mm and hang back technique.
The technique of combined LR recession 7mm and hang back technique:
A. The muscle is exposed in the usual manner and locking suture is passed through full thickness of the LR muscle using nonabsorbable ethibond suture.
B. The muscle is cut from its insertion site. C. Marking the sclera for the rectus muscle recession. a Measurement from the limbus, or b measurement from the original insertion site.
D. Passage of the needles in the sclera using the "crossed swords" Technique E. The muscle has been pulled up to its new insertion point and the sutures have been tied and cut and the remainder of the procedure is identical to the standard hang-back method.
The
干预措施: Evaluation of The Techniques of Lateral Rectus Muscle Combined Recession with Hang Back and Combined Recession with Z-Tenotomy in Correcting Large-Angle Exotropia (Procedure)
结局指标
主要结局
sucessful alignment
时间窗: Follow up period of 6 month from the time of initial surgery. All patients will be examined at one week, one month, 3 month and 6 months.
Successful motor alignment will be defined as orthotropia or ≤ 10 Δ Exotropia or Esotropia at 6 m distance with spectacle correction worn at 6 months. Successful sensory alignment will be by achievement of fusion and moderate or good stereoacuity postoperatively.
次要结局
未报告次要终点
研究者
Basma Gamal Mohamed Ahmed Sayed Ahmed
Assistant lecturer
Tanta University