الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 116 |  |  |
| | | from | 116 | | |
Abstract
Essential infantile esotropia (EIE) is a manifest constant esodeviation that occurs during the first six months of life. characterized by a large-angle of deviation of more than 40 PD with alternation of fixation in the primary position and cross fixation in side gazes, no relevant hyperopic refraction (maximum +2.00 D) and may be associated with oblique muscles overaction. The exact cause of EIE is still unknown, but according to Chavasse’s theory, that abnormal motor alignment during early life affects the early development of binocular single vision. Hence, early intervention is highly recommended to avoid irreversible loss of the ability to attain single binocular vision and normal depth of perception that may occur in neglected cases with delayed surgical intervention. Management of infantile esotropia is mainly surgical. While cases with hypermetropia of more than +2.00 D, were corrected by glasses first. The 5 mm bi-medial recession (BMR) is the favorable approach that’s not sufficient for correction of large-angle deviations of > 50 PD. In large-angle EIE of more than 50PD, three or four horizontal muscles surgery had been the favorable approach. According to Mittleman and Folk (1975), and recently Biedner et al., (1992) they had conducted favorable results after rerecession of MR muscle 13.5 mm away from the limbus in residual esotropia cases. So, recessions larger than 5 mm can be conducted without any fear of limitation of adduction or convergence. This study aims to assess the effect of the supramaximal bi-medial recession of more than 5 mm (7mm) on motor outcome in the correction of large-angle essential infantile esotropia. The study included 30 patients with large-angle infantile esotropia of more than 50 PD who met with inclusion criteria. All cases underwent complete ophthalmological and strabismus examination before and after surgical treatment. All patients underwent a 7 mm bilateral medial rectus muscles recession and completed six months follow-up at one day, one week, one month, three months, and six months. In this study, the success rate was (80%) 24 cases out of 30 cases. This success rate is defined as orthophoria or under-correction within 10 PD (residual esotropia) in primary position, while the failure rate was (20%) 6 cases out of 30 cases. This failure rate is defined as under-correction > 10 PD in the primary position. In our study, we defined surgical success only according to successful motor alignment. Parent’s satisfaction was (80%) after 6 months of follow up. There was a statistically significant relationship between the age at the time of surgery and the surgical outcome, according to the US standard age of surgical intervention in infantile esotropia is 12-18 months, of age, is the age with better results. Also, there was a statistically significant relationship between the preoperative angle of deviation and the surgical outcome, where the smaller the preoperative angle of deviation the better surgical outcome. There was no consecutive exotropia as a complication, but, a long period of follow-up may show any delayed consecutive exotropia. Also, there was no significant limitation of adduction or convergence. This gives an idea that a maximum recession of 7 mm may not be enough for the correction of large-angle infantile esotropia. There were no significant complications as slipped muscles or infection.