Unilateral lateral rectus muscle advancement surgery based on one-fourth of the angle of consecutive esotropia

Jung Yup Kim,Soo Jung Lee

doi:10.1186/s12886-017-0658-1

Abstract

BackgroundTo evaluate the efficacy of unilateral lateral rectus muscle advancement surgery based on one-fourth of the angle of consecutive esotropia within 25 prism diopters (PD) occurring after bilateral lateral rectus muscle recession for intermittent exotropia.MethodsMedical records of 11 patients who underwent unilateral lateral rectus muscle advancement for consecutive esotropia from 2011 to 2014 and who were observed for at least 6 months after surgery were retrospectively reviewed. The change in angle of deviation from before to after consecutive esotropia surgery, as well as the success rate and surgical effect, were evaluated.ResultsPreoperative esodeviation was −19.6 ± 4.7 PD [median − 20.0 PD, interquartile range (IQR) 9.0] at distance and −16.5 ± 7.4 PD [median − 18.0 PD, IQR 17.0] at near. The mean surgical amount of unilateral lateral rectus muscle advancement surgeries, based on one-fourth of the angle of consecutive esotropia, was 4.8 ± 1.1 mm [median 5.0 mm, IQR 2.0]. Of the 11 patients, 10 (91%) recovered to orthotropia or exodeviation within 8 PD. The surgical effects of unilateral lateral rectus muscle advancement were 3.3 ± 0.7 PD/mm [median 3.6 PD/mm, IQR 1.0] after 1 day, 3.7 ± 0.6 PD/mm [median 3.8 PD/mm, IQR 1.0] after 1 week, and 3.8 ± 0.7 PD/mm [median 3.8 PD/mm, IQR 1.5] after 6 months.ConclusionsUnilateral lateral rectus muscle advancement surgery based on one-fourth of the angle of consecutive esotropia within 25 PD was successful in all 11 patients. The surgical effect was significantly greater in unilateral lateral rectus muscle advancement than in primary lateral rectus muscle recession. Reduction in the amount of surgery should be considered carefully in unilateral lateral rectus muscle advancement for consecutive esotropia.

Highlights

To evaluate the efficacy of unilateral lateral rectus muscle advancement surgery based on one-fourth of the angle of consecutive esotropia within 25 prism diopters (PD) occurring after bilateral lateral rectus muscle recession for intermittent exotropia
This study evaluated the effects of unilateral lateral rectus muscle advancement based on one-fourth of the angle of consecutive esotropia within 25 prism diopters (PD) without abduction defect after bilateral lateral rectus muscle recession for intermittent exotropia
Lee et al [2] performed unilateral lateral rectus muscle advancement for consecutive esotropia within 25 PD in eyes with abduction limits, or in deviated eyes if abduction was not limited in either eye

Summary

Introduction

To evaluate the efficacy of unilateral lateral rectus muscle advancement surgery based on one-fourth of the angle of consecutive esotropia within 25 prism diopters (PD) occurring after bilateral lateral rectus muscle recession for intermittent exotropia. The recommended surgical approach for patients with overcorrection following strabismus surgery is dependent on whether eye movement is limited. If eye movement is not limited, surgery on unoperated muscles should be performed as if it were the initial operation; whereas, if there are any limitations in eye movement, Reoperation on unoperated new muscle has several advantages. Even if eye movement is not limited, reoperation on the previously operated muscles may be the preferred option. Reoperation on the previously operated muscles has the following advantages: the condition of the operated muscle can be confirmed; the patient and his/her guardians can avoid the psychological concerns associated with operation on a new muscle; and it leaves muscles available for additional surgery, there is a risk of inaccuracy [4]. Most current surgeons believe in exploring the operated muscle and assess its status before reoperation

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