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

ABSTRACT

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.