Lateral Rectus Recession For Exotropia Research Articles

Does exotropia surgery have a long-term effect on choroidal vasculature?

ObjectiveTo investigate the long-term effect of exotropia surgery on the choroidal structure. Material and methodThe study included 18 patients treated with medial rectus resection and lateral rectus recession for exotropia and 18 healthy patients as a control group. Demographic and clinical characteristics as well as enhanced depth imaging optical coherence tomography (EDI-OCT) scans were collected retrospectively. Images were binarized using ImageJ software; total choroidal area along with luminal and stromal areas (TCA, LA, and SA) were segmented, and CVI was computed as the ratio of LA/TCA. In addition, choroidal thickness (CT) was evaluated. ResultsNo significant differences were found between operated eyes, fellow eyes, and control group eyes in terms of CT, TCA, LA, SA, and CVI. ConclusionStrabismus surgery does not appear to negatively effect the choroidal layer in the long term. We recommend that this surgery be performed without delay as it positively affects the psychological health of the patient and improves quality of life.

This issue of ACTA

This issue of ACTA

Correlation between the axial length and the effect of recession of horizontal rectus muscles

Purpose The aim of this study is to determine whether the axial length (AxL) measurement would be useful in predicting the effect of horizontal rectus muscles recession. Patients and methods This study retrospectively reviewed 94 patients (52 with intermittent exotropia and 42 with infantile esotropia and partially accommodative esotropia), with age ranging from 4 to 15 years (7.63±3.2). All cases underwent bilateral lateral rectus recession for exotropia and bilateral medial recession for esotropia; there were no cases of combined vertical strabismus. There was no history of any ocular trauma or previous strabismus surgery. Preoperative angle of deviation, AxL (IOL Master), and postoperative angle of deviation at 6 months were recorded; effect of recession was calculated in all cases. Results The mean AxL for all cases was 23.39±1.73. The patients were divided into two groups: exotropia group (n=52) and esotropia group (n=42). Each group was subdivided into two subgroups: subgroup I (AxL<23.39) and subgroup II (AxL≥23.39). The effect of recession in exotropic group was 2.27±0.29; in short AxL subgroup, it was 2.42±0.17, and in long AxL subgroup, it was 1.98±0.25. In esotropic group, the effect of recession was 3.36±0.53; in subgroup I, it was 3.67±0.31, and in subgroup II, it was 2.87±0.44. Conclusion The results showed a negative correlation between AxL and effect of recession in both esotropia and exotropia groups. It is recommended to increase the amount of recession in longer AxL.

Contemplation of the Surgical Normogram of Lateral Rectus Recession for Exotropia Associated with Superior Oblique Palsy

PurposeTo suggest a surgical normogram for lateral rectus recession in exotropia associated with unilateral or bilateral superior oblique muscle palsy (SOP).MethodsWe retrospectively reviewed the charts of 71 patients with exotropia who were successfully corrected over one year. Each patient had undergone unilateral or bilateral rectus recession associated with uni- or bilateral inferior oblique (IO) 14 mm recession, using a modified surgical normogram for lateral rectus (LR) recession, which resulted in 1 to 2 mm of reduction of LR recession. We divided all patients into 2 groups, the 34 patients who had undergone LR recession with unilateral IO (UIO) recession group and the remaining 37 patients who had undergone LR recession with bilateral IO (BIO) recession group. Lateral incomitancy was defined when the exoangle was reduced by more than 20% compared to the primary gaze angle. The surgical effects (prism diopters [PD]/mm) of LR recession were compared between the two groups using the previous surgical normogram as a reference (Parks' normogram).ResultsThe mean preoperative exodeviation was 20.4 PD in the UIO group and 26.4 PD in the BIO group. The recession amount of the lateral rectus muscle ranged from 4 to 8.5 mm in the UIO group and 5 to 9 mm in the BIO group. Lateral incomitancy was noted as 36.4% and 70.3% in both groups, respectively (p = 0.02). The effect of LR recession was 3.23 ± 0.84 PD/mm in the UIO group and 2.98 ± 0.62 PD/mm in the BIO group and there was no statistically significant difference between two the groups (p = 0.15).ConclusionsReduction of the LR recession by about 1 to 2 mm was successful and safe to prevent overcorrection when using on IO weakening procedure, irrespective of the laterality of SOP.

One muscle strabismus surgery

To describe recent evidence from the literature regarding one muscle strabismus surgery for small- to moderate-angle horizontal deviations. The use of one muscle surgery for comitant strabismus had been controversial because of concerns that it may result in a significant number of undercorrections and/or produce ocular incomitance. Recent evidence in unilateral lateral rectus recession for exotropia, unilateral medial rectus recession for esotropia, and unilateral rectus resections for undercorrected or recurrent strabismus and convergence or divergence insufficiency suggests that unilateral rectus muscle surgery is a safe, effective and predictable procedure for small- to moderate-angle horizontal deviations. Future prospective, comparative studies with larger samples in unilateral rectus muscle surgery are still needed. Unilateral rectus muscle surgery is a safe, effective and predictable treatment for small- to moderate-angle horizontal deviations. This procedure limits surgery to one eye, leaves other muscles untouched for repeat surgery, and therefore, should be considered as a primary or alternative approach in the treatment of small- to moderate-angle strabismus.

Clinical Audit of Horizontal Strabismus Surgery in Children in Maharashtra, India

Background: The study aimed to audit the results of horizontal strabismus surgery in the hospital’s pediatric ophthalmology department in Maharashtra, India.Method: Medical records of strabismus surgeries done over 3 years were collated. Preoperative visual acuity, deviation, refraction, and orthoptic evaluation were noted as well as post-operative residual deviation and patient satisfaction. Post-operative residual deviation ≤ 10Δ was considered good outcome, 11–20Δ borderline, and > 20Δ was considered poor outcome. The surgeons were briefed about their results periodically and the cause of poor outcomes discussed.Result: Between March 2004 and December 2007, 529 children were operated upon, of whom 461 (87.1%) completed the 6-week follow-up. Average age was 9 years 7 months (range 1–19 years). 260/461 (56.3%) patients had good, 100/461 (21.6%) borderline, and 101/461 (21.9%) had poor outcome. 133/231 (57.6%) cases of esotropia and 127/230 (55.2%) cases of exotropia had a good outcome, while the poor outcome was 50/231 (21.6%) and 51/230 (22.1%), respectively. Bilateral medial rectus recession for esotropia had 25/56 (44.6%) good outcome and 15/56 (26.7%) poor outcome, while recess-resect procedures (R/R) for esotropia had 108/175 (61.7%) good and 35/175 (20%) poor outcome (p = 0.062). Bilateral lateral rectus recession for exotropia had 30/56 (53.6%) good and 12/56 (21.4%) had poor outcome, while for recess-resect procedures for exotropia it was 97/174 (55.7%) good and 39/174 (22.4%) poor outcome (p = 0.97). The result did not significantly change over 3 years. 433/461 (93.9%) expressed satisfaction about the surgery on 6-week follow-up. Large pre-operative deviations and amblyopic eyes accounted for 63/101 (62.3%) cases of poor outcome. Fifty-seven patients recorded an improvement in stereopsis.Conclusion: Recess-resect procedures had better outcome as compared to bilateral recess procedures, but it was not statistically significant. Clinical audit helped maintain and improve good outcome over the 3 years.

A comparison of hang-back with conventional recession surgery for exotropia

The hang-back loop suspension surgical technique for rectus muscle recession offers potential advantages over the conventional rectus muscle recession, including better exposure at the site of scleral sutures, shorter procedure duration, and lower risk of scleral perforation. Previous reports suggest that the hang-back technique for lateral rectus recession for exotropia results in poorer surgical success and may require a different surgical dosage. We compared strabismus in a nonrandomized series of 55 children with exotropia treated with conventional surgery or hang-back surgery. Those in the hang-back (suspension) recession group were on average 2.5 years younger and had 8(Delta) more preoperative exotropia at distance. Surgical outcomes were not significantly different in the two treatment groups. Multivariate logistic regression suggests that outcomes are at least equivalent to conventional surgery after adjusting for age, severity, and other preoperative factors likely associated with outcome. The hang-back surgical technique was as effective as conventional lateral rectus recession surgery for children with exotropia.

Monocular Slanted Lateral Rectus Recession for Exotropia with Convergence Insufficiency

Purpose: To evaluate the efficacy of monocular slanted lateral rectus (LR) muscle recession for exotropia with convergence insufficiency. Methods: Twenty five patients with exotropia greater at near than at versus far distance by ≥10 prism diopters (PD), were divided into two groups: 15 patients who underwent monocular slanted LR recession (study group), and 10 patients who underwent monocular standard LR recession (control group). In the study group, the lower horn of the LR was recessed according to near deviation, the upper horn was recessed according to distance deviation. In the control group, monocular LR was recessed according to distance deviation. The postoperative ocular alignment at distance and near, and the difference between them, were measured and compared retrospectively. The criteria for successful outcome were postoperative residual deviation at near and distance, and the difference of 8 PD or less between the two. Results: The mean distance deviation showed a significant postoperative reduction in both groups (P

Slanted lateral rectus recession for exotropia with convergence weakness

Objective To evaluate the efficacy of slanted recession of the lateral rectus (LR) muscle for exotropia (XT) with convergence weakness. Design Predesigned, nonrandomized, comparative trial. Participants Twelve study patients and six control subjects with XT greater at near than at distance by ≥10 prism diopters (PD). Intervention Twelve consecutive patients underwent slanted LR recession, and six consecutive control subjects underwent standard LR recession. Main outcome measures Between-groups comparison of the postoperative ocular alignment at distance and near, and the difference between them, as well as the stereopsis. Results Slanted LR recession reduced the XT to <8 PD in all patients at distance and in 11/12 patients at near. Additionally, the mean difference between the distance and near exodeviation was reduced from 14 ± 4.5 PD preoperatively to 2.9 ± 2.4 PD postoperatively. All patients in the control group demonstrated postoperative deviations of <8 PD at distance, but all had residual exodeviations >8 PD at near. Three of the study patients gained gross stereopsis postoperatively. Conclusions Slanted recession of the LR is superior to standard recession in reducing both distance and near XT and in collapsing the difference between them. This technique may also have a positive impact on gross stereopsis.