title: Medial rectus muscle elongation, a technique to treat very large-angle esotropia.
abstract: OBJECTIVE
  The purpose was to describe the medial rectus muscle elongation (MRE) procedure to treat very large-angle esotropia (ET) with surgery on a lower number of muscles.
  
  
  METHODS
  Twenty patients with very large-angle ET (more than 70 PD) underwent the MRE procedure. In the MRE procedure, the muscle was split longitudinally into three parts. The wider central part was sutured with 6/0 vicryl and disinserted. The distal end of the peripheral parts (still attached to the original insertion), 7-9 mm away from the insertion, was sutured to the proximal end of the central part. At the end of the procedure, the distance of the anastomosis site from the insertion was named as the final elongation. The dose-response effect of the final elongation was calculated in bilateral MRE cases. The mean of the dose-response effect, obtained in the binocular surgery group, was used in the monocular surgery group to calculate the resection effect of lateral rectus (LR) muscle.
  
  
  RESULTS
  Eleven patients underwent bilateral MRE and nine patients underwent unilateral MRE and LR muscle resection. The mean preoperative far and near deviation was 94.10 ± 19.33 PD. The mean postoperative deviation was 14.60 ± 18.07 PD for far and 14.50 ± 18.23 PD for near deviation. In bilateral MRE cases, the mean dose-response effect of the elongation was 5.53 ± 0.67 PD/mm for far and 5.58 ± 0.69 PD/mm for near deviation. The mean LR muscle resection effect was 6.41 ± 1.99 PD/mm for far and 6.28 ± 1.93 PD/mm for near deviation.
  
  
  CONCLUSIONS
  The MRE procedure seems an acceptable method to treat very large-angle ET with surgery on a lower number of muscles.
authors.affiliation: Farabi Eye Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Ameri
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Akbari
authors.forename: Ali Reza
authors.initials: AR
authors.lastname: Keshtkar Jaafari
authors.forename: Masoud Aghsaei
authors.initials: MA
authors.lastname: Fard
authors.forename: Bahram
authors.initials: B
authors.lastname: Eshraghi
authors.forename: Vida
authors.initials: V
authors.lastname: Tavakoli
authors.forename: Arash
authors.initials: A
authors.lastname: Mirmohammadsadeghi
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004948:Esotropia / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000503:physiopathology / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures; D011446:Prospective Studies; D013536:Suture Techniques; D058971:Tenotomy / Q000379:methods*; D015348:Vision, Binocular / Q000502:physiology; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
references.citation: Clinics (Sao Paulo). 2012;67(3):279-82
references.pmid: 22473411
references.citation: J Pediatr Ophthalmol Strabismus. 1990 May-Jun;27(3):153-6
references.pmid: 2366126
references.citation: Arch Ophthalmol. 1970 Nov;84(5):625-6
references.pmid: 5478890
references.citation: J Pediatr Ophthalmol Strabismus. 2005 Jul-Aug;42(4):211-5
references.pmid: 16121550
references.citation: JAMA Ophthalmol. 2013 Aug;131(8):1041-8
references.pmid: 23699727
references.citation: Oman J Ophthalmol. 2013 Sep;6(3):165-9
references.pmid: 24379550
references.citation: Am J Ophthalmol. 2012 Mar;153(3):560-3
references.pmid: 21996305
references.citation: J AAPOS. 2013 Dec;17(6):578-81
references.pmid: 24210348
references.citation: Arq Bras Oftalmol. 2009 Jan-Feb;72(1):47-56
references.pmid: 19347122
references.citation: Korean J Ophthalmol. 2011 Apr;25(2):139-41
references.pmid: 21461229
references.citation: Clinics (Sao Paulo). 2009;64(4):303-8
references.pmid: 19488586
references.citation: Klin Monbl Augenheilkd. 2011 Oct;228(10):880-6
references.pmid: 21997825
references.citation: J Pediatr Ophthalmol Strabismus. 2014 May-Jun;51(3):160-4
references.pmid: 24654800
references.citation: Br J Ophthalmol. 1994 Nov;78(11):842-4
references.pmid: 7848981
references.citation: Klin Oczna. 1983 Feb;85(2):91-2
references.pmid: 6348393
references.citation: Strabismus. 2010 Dec;18(4):129-36
references.pmid: 21091333
references.citation: Br J Ophthalmol. 1967 Nov;51(11):788-90
references.pmid: 4862858
references.citation: Int Ophthalmol Clin. 1966 Fall;6(3):591-608
references.pmid: 4860340