The Effect of 9 mm, 7 mm Bilateral Superior Rectus Recession for Bilateral Dissociated Vertical Deviation

PURPOSE: To evaluate the effect of 9 mm and 7 mm bilateral recession of the superior rectus muscle in patients with bilateral dissociated vertical deviation (DVD) who had a deviation difference between the non-fixing and fixing eyes of less than 8PD. METHODS: The subjects were chosen from the patients who visited our hospital for DVD between January 2001 and November 2003. We reviewed the surgical records of 19 patients who had undergone 9 mm recession of superior rectus muscle in the non-fixing eye and 7 mm in fixing eye, and who had been followed up for at least 6 months. RESULTS: A residual DVD less than 8PD was regarded as successful. The overall success rate was 73.7%. The success rate of 10~14PD preoperative deviation of the non-fixing eye was 80.0%, and that of 15~19PD preoperative deviation of the non-fixing eye was 75.0%. However, the success rate was 66.7% in recession for the deviation over 20PD. CONCLUSIONS: Bilateral recession of 9 mm and 7 mm of the superior rectus muscle was effective for bilateral DVD in which the deviation difference of the non-fixing eye and fixing eyes was less than 8PD.

A Case of Bilateral Duane's Retraction Syndrome Associated with Goldenhar's Syndrome

PURPOSE: Duane's retraction syndrome is a congenital eye movement disorder caused by innervational disturbance. It is rare that Duane's retraction syndrome is associated with Goldenhar's syndrome which shows systemic congenital malformations. We report a case of bilateral Duane's retraction syndrome associated with Goldenhar's syndrome, which was treated with strabismus surgery and excision of epibulbar lipodermoid. METHODS: A 14-month-old boy with exotropia showed severe limitation of adduction, mild limitation of abduction, globe retraction and palpabral fissure narrowing on attempted adduction in both eyes. He also had a diffuse small epibulabar mass under the lateral conjunctiva in the left eye. The angle of exodeviation was 45PD on alternate prism cover and uncover test. He had had cleft lip, multiple skin tags on the face and preauricular appendages since birth and undergone an operation for these abnormalities at age of 4 months. Bilateral 7.5mm recession of the lateral recti and excisional biopsy of epibulbar mass of the left eye were performed. RESULTS: A case of Duane's retraction syndrome associated with Goldenhar's syndrome was found. The patient obtained orthophoria in his primary gaze after bilateral recession of lateral recti. The epibulbar mass was consistent with lipodermoid on pathologic examination.

Comparison of Surgical Results between Bilateral Recession and Unilateral Recession-Resection in 25 PD Intermittent Exotropia

PURPOSE: It is the purpose of this paper to study the long-term results of surgically treated intermittent exotropia of 25 prism diopters (PD) of preoperative deviation. METHODS: We analyzed and compared 364 patients (376 cases) with at least 6 months of postoperative follow-up. Two surgical methods were done : 6 mm bilateral recession of lateral rectus muscle in 190 patients (190 cases) and unilateral 4 mm recession of lateral rectus muscle combined with 3 mm resection of medial rectus muscle in 174 patients (186 cases). RESULTS: The average age of operation was 6.2 years, ranging from 3 to 16 years, and the follow-up period after surgery ranged 6 to 128 months (mean 27.3 months). The satisfactory surgical result defined as orthophoria and deviation between 5 PD esodeviation and 10 PD exodeviation. The final success rates were 75.3% in bilateral recession group and 64.5% in unilateral recession-resection group. This difference in success rates between the two groups was statistically significant (P=0.023), and the age at operation did not influence the surgical results. Those cases who were over-corrected 6 to 10 PD had a higher success rate and there was a statistically significant relationship between alignment immediately after surgery and on the final postoperative day in the two surgical groups (P=0.0001). CONCLUSIONS: The outcome of the bilateral recession is better than that of the unilateral recession-resection for correction of 25 PD intermittent exotropia in any age group.

Surgical Results of Unilateral and Bilateral Lateral Rectus Recessions in Exotropia under 25 Prism Diopter

It is the purpose of this study to compare the postoperative results of surgery for 39 patients with exotropia under 25 prism diopters (PD). Two surgical methods were done; 8 to 9mm unilateral recission of the lateral rectus muscle in 17 patients (unilateral gruop) and 4 to 6mm bilateal recession in 20 patients (bilateral group). The preoperative deviations on the average were 20.8PD in unilateral and 22.6PD in bilateral grou, and postoperatie corrections on the average were 16.5PD in unilateral and 22.8PD in bilateral group. The 41.2% in unilateral droup and 59.1% in bilateral group were under +/-5PD in postoperative deviation. There were 12 cases (70.6%) in unilateral and 20 cases (90.9%) in bilateral group showing the amount of deviation less than 10PD of under or overcorrection. InBilateral group, higher success rate was observed, but there was no statistical difference (p=0.053) between the two groups. The limitation of abduction was observed in the 4 cases of unilateral group but there was no significant cosmetic problem. From our surgical results, the outcome of the bilateral recission for the lateral rectus muscle is better than that ofthe unilateral recession for the correction of exotropia under 25PD although there was no statistical difference.

Comparison of Surgical Results Between Bilateral Recession and Unilateral Recession-Resection in Intermittent Exotropia

To treat intermittent exotropia, bilateral recession or monocular recession-resection can be chosen. Thirty one cases of intermittent exotropia with preoperative exoangle 25 delta were treated with 8mm bilateral recession (15 cases) and 5.5mm recession of lateral rectus muscle combined with 5mm resection of medial rectus muscle (16 cases). The final surgical results were compared between the 2 groups. The surgical results were as follows: in bilateral recession group, 33.3% was satisfactory, 60.0% undercorrected, and 6.7% overcorrected with 13.7 months of follow-up in average, in monocular recession-resection group, 50.0% was satisfactory, 18.8% undercorrected, and 31.3% overcorrected with 13.0 months of follow-up in average. Monocular recession-resection procedure had better satisfactory result than that of bilateral recession procedure. The author agrees the opmion that recession-resection produces a more permanent result than recession alone because the resection of the medial rectus muscle locks the eye in better alignment, preserving the benefit of the recessed lateral rectus muscle.