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Year : 2016  |  Volume : 109  |  Issue : 1  |  Page : 10-15

Bimedial faden recession versus augmented medial rectus recession in the treatment of high ac/a ratio partially accommodative esotropia with large distant near disparity

Department of Ophthalmology, Benha University, Benha, Egypt

Correspondence Address:
Ahmed M Saeed
33rd El-Horreya Street, El-Sherif Tower, El-Kanater El Khaireya 13621
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2090-0686.192744

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Purpose The purpose of this study was to compare the results of medial rectus (MR) Faden recession (FR) with MR augmented recession (AR) in the management of large distant–near disparity (DND), in convergenceexcess, partially accommodative esotropia (ET) associated with a high accommodative convergence/accommodation (AC/A) ratio. Patients and methods This is a prospective interventional study of 31 patients with convergence excess partially accommodative ET associated with a high AC/A ratio. Patients were divided into two groups. Group FR, which contains 15 patients who were treated by bimedial FR, and group AR, which contains 16 patients who underwent augmented MR recession based on the angle of near deviation. Surgical success was defined as distant and near ET≤10 prism diopter with shrinkage of high AC/A ratio and high DND. Results Surgical success was achieved in 93.3% of cases in the FR group and in 81.2% of cases in the AR group. In the FR group, mean DND decreased from 33.3±11.5 to 3.06±2.08 prism diopter. For the AR group, mean DND decreased from 25.3±7.1 prism diopter preoperatively to 5.3±2.5 prism diopter postoperatively. The difference between both groups regarding reduction of DND was statistically significant (P<0.05). The mean AC/A ratio decreased from 8.6±2.5 to 2.3±1.3 prism diopter/diopter and from 7.3±1.9 to 2.1±0.9 prism diopter/diopter in the FR and AR groups, respectively, with no statistically significant difference between both groups. Two cases in the AR group with large DND (40 and 50 prism diopter) developed consecutive exotropia. Conclusion Faden recession achieves marginal superior control of DND and high AC/A ratio in convergence excess partially accommodative ET. Augmented recession also works well with the possible development of consecutive exotropia in cases with extremely high DND. This study recommends Augmented recession for cases with mild to moderate DND and Faden recession for cases with extremely large DND.

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