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Comparison of Modified Anchored “Hang-Back Technique (HBT)” With Conventional HBT in Bimedial Rectus Recession

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Purpose: We conducted a retrospective study to establish whether bimedial rectus recession (BMR) using a modified “hang-back technique” (HBT) is comparable with conventional HBT. Methods: Consecutive patients younger than the age of 16 underwent BMR during 1999 and 2000 with at least a 6-month postoperative follow-up period were included. In 1999, all patients had operations performed with conventional HBT, whereas those in 2000 were conducted with modified HBT. Angles of strabismus were measured preoperatively and at 2 weeks, 2 months, and 6 months postoperatively. Results: Thirty-nine and 43 patients underwent BMR using conventional and modified HBT respectively. Preoperative angles for near and distance were 43.6 (PD) versus 43.5 PD and 36.4 PD versus 36.8 PD. At 6 months’ postop, the mean angles for near and distance were 6.4 PD Eso (range, 35 PD Eso - 40 PD Exo) and 5.4 PD Eso (range, 35 PD Eso - 35 PD Exo) in the conventional group: 8.1 PD Eso (range, 35 PD Eso - 20 PD Exo) and 6.3 PD Eso (range, 35 PD Eso - 25 PD Exo) in the modified group. The overall success rate (alignment to within 10 PD of orthotropia for distance and near) was similar between the two groups (conventional HBT:69.2% vs. modified HBT: 67.4%, P = 0.352). However, modified HBT was found to be associated with significantly lower consecutive exotropia rate postoperatively at 6 months (4.7% vs. 20.5%, P = 0.031). Conclusion: BMR using modified HBT is as effective as conventional HBT but with a significantly lower consecutive exotropia rate.

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Data Collection and Outcome Measure

Consecutive patients younger than the age of 16 who underwent bimedial rectus recession during 1999 and 2000 with at least 6 months of postoperative follow-up period were included in this retrospective study. In 1999, all patients had operations performed with the conventional HBT, whereas those patients in 2000 underwent with the modified technique. Some of the patients also had an additional procedure, such as vertical transposition of horizontal recti, conjunctival recession, and inferior

Results

There were 39 patients in the conventional HBT group and 43 in the modified group who met our inclusion criteria. The mean age, sex, onset, and presentation of strabismus and timing of surgery are summarized in Table 2. Of all the patients, 64.1% (25/39) in the conventional HBT group and 67.4% (29/43) in the modified HBT group required spectacle correction for hypermetropia, respectively. Preoperatively, 18 of 39 (46.2%) were found to be amblyopic in the conventional group and 21 of 43 (51.2%)

Discussion

Consecutive exotropia is a common problem after esotropia correction surgery. The rate varies from 4% to as high as 38%.14, 15, 16, 17 A higher rate of consecutive exotropia was shown to be associated with surgery in patients younger than 7 months of age,17 amblyopia,18 the presence of preoperative A or V patterns, high hypermetropia, or postoperative limitation on adduction.18, 19, 20 In our study, none of these factors was found to be contributory apart from postoperative limitation on

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