Surgical Management of Residual Infantile Esotropia Using Lyophilized Bovine Pericardium - A Case Series of 29 Patients.

ABSTRACT: PURPOSE: This study aimed to assess the effectiveness of tendon elongation using Tutopatch as a secondary intervention for residual infantile esotropia, particularly in patients exhibiting limited abduction, for whom further conventional surgery might not yield successful outcomes.

ABSTRACT:

METHODS

Design

This retrospective study analysed data from patients with residual deviation angles following previous surgery for infantile esotropia. Participants and intervention: All patients who underwent tendon elongation with Tutopatch between 2009 and 2023 were included in the study, excluding those with other ocular or strabismus diagnoses or those who refused to participate.

Setting

The data were collected from patients operated at a single tertiary medical centre. The analysis included pre- and postoperative deviation angles recorded at one day, three months, and twelve months, if available. The dose-effect relationship, defined as the deviation angle in degrees per effective operative distance in millimetres, and overall success rates were determined. Primary and secondary outcome measures: The primary outcome measure was the effect of using Tutopatch on the deviation angle. The secondary measure was the effect on ocular motility.

ABSTRACT:

RESULTS

Participants and intervention: The study included twenty-nine patients (ten females, 19 males) with a median age of 17 years (range: 5 - 59 years). The median preoperative deviation angle was + 15° (range: + 6° to + 27°), which decreased to - 1.5° (range: - 12° to + 7°) at the three-month follow-up in 22 patients. Subsequent long-term follow-up in ten patients, after a median duration of 34.5 months (range: 13 to 69 months), revealed a median deviation angle of - 1° (range: - 15° to + 15°). Postoperative adduction was slightly reduced, by a median of 5° (range: loss of 30° to gain of 15°). No postoperative complications were observed. Overcorrection necessitated re-operation in five patients, which was uneventful. The median postoperative deviation angle following re-operation was - 1° (range: - 5° to + 8°).

ABSTRACT:

CONCLUSION

Tendon elongation with Tutopatch is effective in managing significant residual infantile esotropia, particularly in complex cases, with minimal impact on duction limitation. Long-term overcorrection may occur, necessitating re-operation that can be performed without difficulty.