Session: Free papers Session IV - Eye muscle surgery

Combined recession and resection of the same rectus muscle (RRSM) in the treatment of concomitant esotropia and exotropia. Indication, technique and first results.

Introduction: The recess and resect procedure on the same muscle (RRSM) combines the effect of a classic recession and a fadenoperation and  therefore makes it possible to act on the anatomical and tonic parts of the deviations in a single procedure. We have recently published our results with this technique in tonic esotropias and exotropias.

Methods: RRSM consists in a large recession, which decreases the active and passive force of the muscle and strongly decreases the arc of contact, almost as the fadenoperation. Muscle underaction and risk of overcorrection are limited by combining a muscle resection appropriately tuned with the quantified passive duction tests.

Results: In our series of 65 cases of esotropia with eyes that straighten under general anesthesia (GA), the technique was compared to fadenoperation alone. It is as effective (81% success rate at 6 months compared to 90% for faden) without its main drawbacks. We now indicate RRSM in a broader way in surgery of esotropias including a tonic factor where the fadenoperation would be indicated but is not optimal: significant ametropia, adults, fragile globes, associated alphabetical syndroms.

In exotropia, the results are very encouraging and seem to confirm that a tonic factor is partly involved in these strabismus. On 100 cases of exotropia decreasing under GA operated with RRSM, our results are superior to those usually obtained with more than 6 months of follow-up (83% success on alternating CT and 100% improvement in control scores) .

Moreover, in both situations, the observation of the long-term evolution of the two series (over 5 years for esotropias and 2 years for exotropias) shows a good stability of the success rate.

Conclusion: Given these encouraging results, we believe that this technique, which elegantly allows the tonic and anatomical aspects of concomitant strabismus to be treated in a single, simple surgical procedure, should enter our surgical therapeutic arsenal for concomitant strabismus.