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The authors evaluate a fenestration technique which is described as a modified sutureless hang-back recession, for cases of partially accommodative esotropia, in a prospective non-controlled cohort. Children under 10-years-old with full accommodative correction and a partially accommodative esotropia between 10 and 35 prism dioptres were included. Those with a near-distance disparity greater than 10 prism dioptres were excluded. The authors describe the surgical technique along with a dosage table. Sixty-one children completed at least three months follow-up. None of the participants had demonstrable sensory fusion or measurable stereoacuity pre-op. The mean pre-op angle was 24 and 22 prism dioptres for near and distance respectively. Satisfactory horizontal alignment was reported in 89% of the cases at six-month follow-up, with a mean post-op angle of five and three prism dioptres for near and distance respectively. Those that had unsatisfactory alignment post-op were all undercorrected. Seven children (12%) underwent a reoperation of a single lateral rectus resection. The authors describe the results of the procedure as reducing the esotropia at distance without resulting in an overcorrection at near, and is comparable with nonabsorbable suture hang-back recession. Limitations of this study are listed as including small sample size and lack of a control group. Further study is required with this surgical technique.

Treatment of partially accommodative esotropia in children using a medial rectus muscle fenestration technique.
Elkhawaga M, Kassem A, Helaly H, et al.
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Lauren R Hepworth

University of Liverpool; Honorary Stroke Specialist Clinical Orthoptist, Northern Care Alliance NHS Foundation Trust; St Helen’s and Knowsley NHS Foundation Trust, UK.

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