Long-term results of augmented unilateral lateral rectus muscle recession for dissociated horizontal deviation.

In Jeong Lyu,Sei Yeul Oh,Jong Chul Han,Ahmed Awadein

doi:10.1371/journal.pone.0234017

Abstract

We report the long-term surgical results of augmented lateral rectus muscle (LR) recession for dissociated horizontal deviation (DHD) without concomitant exotropia (XT) or esotropia (ET). This retrospective review included patients with DHD without XT or ET who underwent augmented LR recession and were followed-up for ≥12 months. Each patient’s medical records were evaluated to identify their demographics, preoperative angle of deviation, surgical procedure, success rate, and reoperation rate. A total of 11 patients with DHD were included (median patient age at surgery, 6 years; interquartile range [IQR], 5 to 10 years). Four patients (36.4%) had a history of infantile ET while three patients (27.3%) had a history of unilateral cataract surgery for congenital cataract. The median preoperative angle of DHD in the unilateral eye was 20 prism diopters (PD) (IQR, 15 to 25 PD). The median amount of LR recession was 8.0 mm (IQR, 7.5 to 8.0 mm). Three patients (27.3%) underwent simultaneous surgery for dissociated vertical deviation. At the final examination after a median follow-up period of 32 months (IQR, 24 to 58 months), 10 patients (91%) showed successful alignment. The long-term successful alignment rate after augmented LR recession for DHD was good; thus, application of this technique is appropriate in patients with DHD.

Highlights

Dissociated strabismus complex (DSC) is a slow, disconjugate ocular deviation that elevates, abducts, and excyclotorts the eye.[1]
We retrospectively evaluated the records of patients aged
When the size of the vertical deviation changed in the abduction, adduction, primary, and head tilt positions, we carefully examined the coexistence of abnormal inferior oblique (IO) or superior oblique (SO) function that caused incomitant dissociated vertical deviation (DVD)

Summary

Introduction

Dissociated strabismus complex (DSC) is a slow, disconjugate ocular deviation that elevates, abducts, and excyclotorts the eye.[1] It is usually bilateral and asymmetric. DSC occurs when normal binocular visual development is disrupted by infantile esotropia (ET) or exotropia (XT), congenital cataract, congenital optic nerve or retinal disease, and amblyopia.[2,3,4] The most common subtype of DSC is dissociated vertical deviation (DVD), which is characterized by slow elevation of the non-fixating eye.[5] In contrast to DVD, dissociated horizontal deviation (DHD) is a less well-known manifestation of DSC and is diagnosed when the horizontal component of DSC is exaggerated. It can be distinguished from intermittent XT by its asymmetry of the exodeviation between two eyes, and association with vertical and torsional movements.[1]

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