The Effect of Monocular recession and Resection in Exodeviations: Comparison between Primary, Right, Left, Up, Down and Near Gaze

In order to evaluate the incidence of lateral incomitance after monocular recession and resection and compare the amount of correction achieved by monocular recession and resection according to the gaze direction and distance in exodeviations, we measured the angle of deviation in primary, right, left, up, down and near gaze before and after monocular recession and resection. Lateral incomitance was developed in11.4%(9/79) after monocular recession and resection. The amount of correction of the deviation toward the side of operated eye was larger than that of the deviation in primary position(p=0.002), but the amount of correction of the deviation toward the side of non-operated eye, up, down and near gaze was all smaller than that of the deviation in primary position(all, p<0.01).

Infantile Esotropia

Authors reviewed 53 infantile esotropia patients in 218 patients who had undergone surgery for esotropia from January, 1986 to March, 1988. Of 53 patients, male were 29(54.7%) and female were 24(45.3%). Age when first seen by us ranged from 6 months to 12 years and 4 months. Patients with age below 2 years old were 28(52.7%). 32 patients(60.4%) had alternate fixation and 21 patients(39.6%) had monocular fixation. Angle of deviation over 35 prism diopters was found in 41 patients(77.4%). By cycloplegic refraction, of 106 eyes, 81 eyes(76.4%) were low hyperopes(plano - +3.0D). Associated clinical findings were inferior oblique overactions in 37 patients(69.8%), dissociated vertical divergences in 18 patients(34.0%), latent nystagmus in 3 patients(5.7%), superior oblique overaction in 1 patient(1.9%). The monocular recession and resection was performed as an initial surgical procedure. If a second procedure was required, same procedure was performed in the fellow eye. In the patients with inferior oblique overaction, inferior oblique myectomy was performed. Mean age at the time of operation was 4 years and 2 months. After surgery, of 53 patients, 45 patients were followed up for 6 months or over. Of 45 patients, postoperative angle within 10 prism diopters of orthophoria was found in 16(35.6%) after initial operation and in 33(73.3%) after reoperation. In patients with large angle of esodeviation(greater than 40 prism diopters), 6mm recession seemed to provide better results than 5mm recession after initial recess-resect procedure.