Anchored versus conventional hang-back technique in large bimedial rectus recession

Abstract

Purpose To compare surgical outcome of anchored hang-back technique (HBT) against conventional HBT in bimedial rectus-muscle recession (BMR) for large-angle esotropia. Design A retrospective nonrandomized comparative interventional study. Participants In total, 94 patients with esotropia and indicated for at least 6-mm BMR. Methods Patients were randomly assigned into two groups according to surgical technique of BMR: (a) anchored HBT and (b) conventional HBT. Postoperatively, angles of deviation were quantified for near and far. Alignment within 10-prism diopters (PD) of orthotropia was considered a successful result by the end of 6 months. Kaplan–Meier analysis was used to determine the cumulative survival in both groups. Results In total, 48 patients underwent conventional HBT and 46 patients in the anchored HBT. Preoperatively, mean angles of deviation for near and far were 61.6 and 60.1 PD in the conventional group, versus 62.2 and 60.4 PD in the anchored group, respectively (P>0.05). By the sixth postoperative month, the mean angles of deviation for near and far in the conventional group were –1.4 and –3.4 PD, versus 1.2 and 0.1 PD in the anchored group, respectively (P=0.03). Success rate was 76% in the conventional group, versus 87.5% in the anchored group (P=0.03). Kaplan–Meier survival analysis showed a significantly higher cumulative 6-month incidence of failure in the conventional HBT group than the anchored one (P=0.025, Log rank). Conclusion Anchored HBT showed a higher efficacy than conventional HBT in large BMR recession.