Evaluation of fenestration technique of the medial recuts muscle with resection of ipsilateral lateral rectus muscle in patients with sensory esotropia

Background There is an ongoing need to move toward sutureless surgery with less surgical manipulations, while maintaining the same results achieved by conventional surgery. Aim The aim was to evaluate the safety and the effectiveness of fenestration technique of the medial recuts muscle with resection of ipsilateral lateral rectus muscle in patients with sensory esotropia. Design A prospective, noncomparative, single-institution interventional study was conducted. Patients and methods This is a prospective study conducted on 16 children with sensory esotropia. Fenestration of the medial rectus muscle is a novel technique of weakening of the medial rectus by excising a rectangular wide central part extending from the insertion to a point back 5–8 mm depending on the angle of the esotropia leaving superior and inferior longitudinal muscle sleeves with no muscle sutures needed. Postoperative angle was reported at 3 months and at final follow-up. Results The procedure reduced the angle of esotropia from mean preoperative angle of 36.6±9 (20–50) to 5.3±5.9 (0–20) PD. Satisfactory horizontal alignment, defined as postoperative alignment within 8 PD of orthotropia at distance, was achieved in 81.25% of the cases at 3 months of follow-up. There were no overcorrections. The procedure was well tolerated by patients. Conclusion Fenestration technique is a safe and effective weakening procedure for medial rectus in cases of sensory esotropia.