Session: Free papers Session V - Esotropia 2

Surgical management of residual infantile esotropia using lyophilized bovine pericardium (Tutopatch®)

Purpose: To evaluate tendon elongation with Tutopatch® for secondary management of residual infantile esotropia, particularly in patients with limited abduction due to secondary restrictios and when a further conventional surgery might not be successful.  



Methods: The data of patients with residual infantile esotropia, managed using Tutopatch® between 2009 and 2023, were analysed. Those include the preoperative deviation angle and the postoperative angle at one day, three months, and 12 months. The dose-effect relationship (deviation angle in degrees per effective operative distance in mm) and the overall success were analyzed.  



Results: Twenty-nine patients were included in our study.The median preoperative deviation angle was +15° (range +6° to +27°) which had decreased to -1.5° (range -12° to +7°) at the three-month follow-up in 22 patients. A late follow-up in ten patients after a median of 34.5 months (range 13 to 69 months) showed a median deviation angle of -1° (range -15° to +15°). The postoperative adduction reduced with a median of 5° ( range loss of 25° and gain of 15°). 

No postoperative complications were observed. An overcorrection had to be re-operated in five patients, which was uneventful. The median postoperative deviation angle was then -1° (range -5° to +8°).  



Conclusion: The management of significant residual infantile esotropia by tendon elongation using Tutopatch® is helpful, in some complicated cases, with little effect on duction limitation. Overcorrection may occur in some patients in the long-term. In such cases, the patients can be re-operated without difficulty.  



Keywords: infantile esotropia, medial rectus recession, tendon elongation, Tutopatch®.