Effect of Both Lateral Rectus Recession in Large Angle Exotropia

PURPOSE: To evaluate of the effect of both lateral rectus recession according to the amount of the recession in the patients who showed large angle (>or=35 prism diopter, PD) exotropia. METHODS: The 120 patients who underwent both lateral rectus recession and followed up more than 1 year between 1996 to 2002 at Chung-nam university hospital, were reviewed. The effect of both lateral rectus recession was compared according to the amount of recession and preoperative angle of deviation. Successful outcome was defined as esotropia

Effect of Both Lateral Rectus Resection for Residual Esotropia

PURPOSE: To investigate the surgical outcome of both lateral rectus resection in the treatment of residual esotropia with previous both medial rectus recession METHODS: The medical record of 30 patients who had underwent both lateral rectus resection from 1996 to 2001 for residual esotropia occurred after bilateral medial rectus recession and who had followed up for more than one year, were analysed retrospectively. Successful outcome was defined as esotropia 0.05), but it was not significant statistically. Postoperative angle of deviation in group II was increased from 8.1+/-4.6PD at postoperative 1 day to 13.8+/-7.9PD at postoperative 1 year (p<0.001). CONCLUSIONS: Both lateral rectus resection is an effective method in the treatment of residual esotropia less than 40 PD.

Effect of Unilateral Lateral Rectus Recession for Intermittent Exotropia under 25 PD

PURPOSE: To investigate the surgical outcome of unilateral lateral rectus recesssion in the treatment of intermittent exotropia under 25 prism diopter (PD). METHODS: The 62 patients who had underwent unilateral lateral rectus recession and followed up for 6 months or larger, were reviewed. Following inferotemporal fornix incision, 8.5 mm or 9.5 mm recession from the insertion of lateral rectus was performed in 20 PD or in 25 PD intermittent exotropia respectively. RESULTS: Mean age of patients was 8.8 years (5-14 years) and follow up time was 11.5 months (6-34 months) on average. Postoperative deviation and success rate were as followings: -0.2+/-2.1 PD, 91.9% at postoperative 1 day, 0.5+/-2.3 PD, 95.2% at postoperative 1 week, 2.5+/-3.9 PD, 96.8% at postoperative 1 month, 3.7+/-5.0 PD, 91.9% at postoperative 6 month and 4.3+/-5.5 PD, 85.7% at postoperative 1 year. The average divergent shift was 4.5 PD during whole examination period and this shift showed significant change during same period (Repeated measures, p=0.000). The occurrence rate of undercorrection was 1.6% at postoperative 1 week, 3.2% at postoperative 1 month, 8.1% at postoperative 6 month and 14.3% at postoperative 1 year. The occurrence rate of overcorrection was 8.1% at postoperative 1 day and 3.2% at postoperative 1 week. All cases of overcorrection were orthophoric after postoperative 1 month. The limitation of abduction was not discovered in all cases at postoperative 1 year. CONCLUSIONS: Unilateral recession of lateral rectus is an effective method in the treatment of intermittent exotropia under 25 PD. However long term follow up should be considered since undercorrection seems to be increasing.

Surgical Results of Classic Harada-Ito Procedure with Intraoperative Adjustment for Excyclotorsion

PURPOSE: We evaluated the efficacy of classic Harada-Ito procedure with intraoperative adjustment for excyclotorsion. METHODS: This study represents a retrospective review of 22 patients surgically treated for the diagnosis of excyclotorsion with abnormal head posture between January 1995 and August 2001. Head tilt, facial asymmetry, diplopia and excyclotorsion were measured preoperatively and postoperatively. Intraoperative adjustment was made by observing the torsional position of the fundus with indirect ophthalmoscopy. Cyclotropia was measured with the Maddox double-rod test or fundus photography with the eyes in primary and down gaze. RESULTS: Causes of excyclotorsion were congenital (7 patients, 32%), trauma (11 patients, 50%)and idiopathic (4 patients, 18%). Of the 22 patients, 19 patients had a head tilt toward the nonparetic side and the others paretic side. Head tilt was uniformly eliminated in 19 of 22 patients (86%). Six of 22 patients had facial asymmertry. After surgical correction, facial asymmetry gradually disappeared in 2 congenital patients. Preoperatively fourteen of 22 patients had diplopia. Postoperatively, eighth of patients had no diplopia and the others had improved of the symptom except one case. The median measured value change of excyclotorsion before and after the surgery in the primary position was reduced from 7.2+/-5.2degrees to 1.7+/-2.8degrees (76%) and 5.3+/-2.2degrees to 0.4+/-1.1degrees in congenital patients, from 8.9+/- 6.6degrees to 1.5+/-2.6degrees in trauma and from 6.0+/-3.4degrees to 4.3+/-4.2degrees in idiopathic. In downgaze, the median measured value change from 10.9+/-5.3degrees to 2.9+/-3.3degrees (73%) and 7.0+/-3.9degrees to 1.1+/-3.0degrees in congenital patients, from 13.2+/-5.7degrees to 3.2+/-3.0degrees in trauma and from 11.5+/-1.0degrees to 5.0+/-4.1degrees in idiopathic. CONCLUSIONS: Intraoperative adjustable classic Harada-Ito procedure was an effective treatment in correcting head tilt, facial asymmetry and diplopia.