[Combined recession and resection of the same rectus muscle: An alternative to posterior fixation sutures. Techniques and results in esotropia and exotropia].

INTRODUCTION

The surgical procedure of combined resection and resection of the same muscle (CRR) has been proposed thus far for overactive muscles. We recently published our short-term results with this technique used in esotropia and in exotropia. We present the long-term results of these two series.

METHODS

CRR consists of a large recession, which decreases the active and passive force of the muscle and greatly reduces the arc of contact, like posterior fixation sutures. The risk of overcorrection and muscle underaction are limited by combining a muscle resection adjusted according to the Quantified Passive Duction Test. We describe in detail the method of action, as well as the surgical technique and titration according to the muscle and the type of strabismus.

RESULTS

In purely constant esotropia, the technique was compared to posterior fixation sutures on the medial rectus. While equally effective at 6 months, we observe greater stability at 5 years with CRR (90% success vs. 55% with posterior fixation sutures). For exotropia, in 100 cases of exotropia operated with CRR of the lateral rectus, our results with more than 2 years of follow-up are superior to those usually obtained, with 83% success on alternating cover test and 100% improvement of Newcastle Control Scores.

CONCLUSION

In view of these encouraging results, we believe that this technique, which elegantly allows treatment of the tonic and anatomic aspects of comitant strabismus in a single, simple, surgical procedure, should be included in our surgical therapeutic arsenal for comitant strabismus.