Lateral Rectus Resection Research Articles

Lateral rectus resection versus lateral rectus plication in patients with residual esotropia

Background Muscle resection or plication is a common treatment for strabismus by strengthening the muscle. Lateral rectus muscle resection is a basic surgical technique for correcting residual esotropia. Plication approach is an alternative surgical technique to resection. Aim Is to compare the result of lateral rectus plication versus lateral rectus resection in patients with residual esotropia. Patients and methods This is a prospective, comparative, randomized interventional study which was carried on 40 eyes of 20 patients with residual esotropia All the patients underwent surgery to both eyes, they were divided into two groups according to surgical technique. Group A: 20 eyes of 10 patients underwent lateral rectus resection surgery. Group B: 20 eyes of 10 patients underwent lateral rectus plication. Results Postoperative success rate in two groups was 80% with main postoperative angle of deviation higher on group B. Conclusion Lateral rectus muscle plication technique is an alternative to resection that has the same effect as resection as obvious by the similar success rate that can be used on horizontal muscles especially when anterior ciliary vessel sparing is needed.

The changes in ocular torsion after unilateral lateral rectus recession-medial rectus resection for intermittent exotropia

We aim to explore the alterations of objective ocular torsion after unilateral lateral rectus recession-medial rectus resection (R&R) for intermittent exotropia (IXT). Seventy-two IXT patients undergoing R&R between March and June 2023 were enrolled. Ophthalmological examinations were performed before surgery and at 1 week and 1 month after surgery, mainly including prism and alternate cover test and optical coherence tomography. The mean disc-foveal angle of eyes showing intorsion significantly increased from − 1.5 ± 0.9° preoperatively to 2.0 ± 2.0° at 1 week (P = 0.0227) and 2.2 ± 1.6° at 1 month postoperatively (P = 0.0054). The mean disc-foveal angle of eyes exhibiting extorsion significantly reduced from 12.8 ± 1.9° preoperatively to 9.8 ± 3.1° at 1 week (P < 0.0001) and 9.7 ± 2.7° at 1 month postoperatively (P < 0.0001). The improvement of ocular extorsion at postoperative 1 month was more pronounced in patients with extorsion in operative eye compared to those with extorsion in inoperative eye (P = 0.0101). The improvement of ocular torsion was observed following R&R for IXT, with a greater effect noted in cases where the surgery was performed on the eye exhibiting extorsion.

The role of lateral rectus muscle resection for severe esotropia after medial rectus muscle myectomy in Graves' ophthalmopathy.

Persistent diplopia after rectus muscle myectomy is not uncommon but challenging in patients with Graves' ophthalmopathy. We investigated the role of lateral rectus muscle resection for patients after medial rectus muscle myectomy in Graves' ophthalmopathy. We retrospectively reviewed and collected data from patients with persistent diplopia after medial rectus muscle myectomy for Graves' ophthalmopathy who underwent unilateral or bilateral lateral rectus muscle resection. The eyeball deviations in the primary and reading positions before and after the operation were measured. A successful surgical outcome was defined as having less than five prism diopters (PD) in the primary gaze and functional binocular vision in the central 30° field postoperatively. A total of fifteen patients were included (mean post-myectomy deviation: 35.9 PD, range: 14 to -75 PD). The lateral rectus muscle resection after medial rectus muscle myectomy achieved an 80.0% success rate, with one patient over-corrected and two patients under-corrected. The lateral rectus muscle resection is an effective and predictable procedure for managing residual esotropia in Graves' ophthalmopathy patients who have previously undergone medial rectus muscle myectomy.

Long-Term Effects of Botulinum Toxin A Versus Incisional Surgery for Management of Partially Accommodative Esotropia in Children: Comparison of Three Approaches

Purpose: To compare the effect of bilateral medial rectus injection of botulinum toxin A (BTX-A), bilateral medial rectus muscle recession surgery (BMR rc), or unilateral medial rectus muscle recession combined with lateral rectus muscle resection surgery (R&R), in the management of partially accommodative esotropia (PAET) in children.Design: Retrospective comparative clinical study.Methods: The study cohort included 98 patients diagnosed with PAET who had BTX-A injection or incisional surgery between December 2014 and January 2023. The main outcome measures included motor and sensory results as well as complications. Follow-up was at least 12 months for all patients.Results: There were 28 patients in the BTX-A group, 45 in the R&R group, and 25 in the BMR rc group. The motor success rates at distance and near fixation respectively were 50% (14/28) and 54% (15/28) in the BTX-A group, which were lower than that of the R&R group [78% (35/45), 84% (38/45)] and the BMR rc group [72% (18/25), 84% (21/25)] (P = 0.042 for near and P=0.006 for distance). For patients with onset age <2.5 years old, there was no statistical difference amongst the three surgical approaches (P=0.656). For patients with onset age ≥2.5 years, the motor success rate of the R&R group [81% (26/32)] and the BMR rc group [88% (14/16)] was higher than that in the BTX-A group [38% (5/13); P=0.004]. There was no statistical difference in sensory outcomes for patients regardless of onset age or treatment methods (P>0.05 for all). During follow-up, 4% (2/45) of patients in the R&R group and 20% (5/25) in the BMR rc group developed consecutive exotropia; no patient in the BTX-A group was overcorrected (P=0.017).Conclusions: Bilateral medial rectus muscle injection with BTX-A in patients with PAET is a safe, accessible, and low-cost alternative. Although motor success rates were higher, overall, in patients treated with incisional surgery, for patients with earlier age of onset (≤ 2.5 years old), BTX-A injection may be preferred to incisional surgery. In older children treated with unilateral recession-resection surgery, fewer developed consecutive exotropia.

Combined recession and resection of the same lateral Rectus in the treatment of exotropia.

Besides rest position abnormalities, exotropia could also be due to hypertonia of the Lateral Recti (LR) given divergence frequently decreases under general anesthesia (GA). Combined Recession-Resection of the Same Muscle (RRSM) is a promising alternative to the Faden procedure in the surgical treatment of overacting MR in esotropia. We thus examined here the effectiveness of combined RRSM of the LR for the treatment of exotropia that decrease under GA. We performed a retrospective, single-center evaluation over a 16-month period of 100 patients operated on for exotropia that decreased under deep GA (91% of 110 consecutive operated cases). We excluded re-operations and pure convergence insufficiencies. We performed a combined RRSM of one or two LR. It included a 10mm-recession and a "fine-tuned" resection of LR based on Quantitative Forced Duction Test scores. MR resection was combined when exotropia exceeded 35PD or for unilateral surgery. We report on patient outcomes 6 months after surgery. Successful results were obtained (-8-+8 PD measured on Alternate Cover Test) among 83% of cases at distance fixation and 91% at near fixation after 6 months. The Newcastle Control Score also improved from 5.8 to 1.7 after 6 months. No surgery-related complications or repeat surgeries were reported. In our experience a majority of exotropias decrease under GA and our strategy of combined RRSM of the LR is effective for the treatment of such exotropias. Long-term follow-up of the cohort is required to investigate the stability of these outcomes, and confirmation of our results by other works.

Prosthetic Contact Lens Combined with Strabismus Surgery : Confronting Psychosocial Prejudice in Anomalous and Misaligned Eyes

Introduction : Patients with defects in the cornea such as abnormal size, opacities as well as misalignment of the eyes may feel inferior about their physical appearance. Such patients will benefit from prosthetic contact lenses (CL) and strabismus surgery to restore anatomical appearance. The majority of patients also seek strabismus surgery for both cosmetic and psychosocial reasons along with decreased levels of anxiety and depression. Our goal not merely cosmetic, but also improving psychosocial health and quality of life.&#x0D; Case Illustration : We reported a 14-year-old male with complaints of white spot on his left eye and squint since birth. On ophthalmology examination, we found 45 degree esotropia with BCVA 6/6 in the right eye and 1/300 in the left eye. Corneal diameter was 10 mm and 9 mm on the right and left eye, respectively. He was diagnosed with right eye posterior embryotoxon, left eye corneal dystrophy, microcornea on both eye, congenital esotropia and deprivative amblyopia. He had developed low self-esteem due to his eyes. To enhance his appearance, left eye lateral rectus resection and medial rectus recession with adjustable suture was done to align the eye. Afterwards, brown-tinted soft contact lens with power -0.50 D, diameter 14,2 mm, and base curve 8,5 mm was given to disguise the corneal opacities and microcornea. Patient felt very satisfied with the result.&#x0D; Discussion : &#x0D; Conclusion : Prosthetic contact lens combined with strabismus surgery provides satisfactory cosmetic and psychosocial benefit with minimal complications. As clinicians, functional, cosmetic and psychosocial indications must be considered for a comprehensive management.

Yokoyama procedure for cyclic strabismus with axial high myopia:a case report

BackgroundIt is a very rare form of ocular motility characterized by alternating strabismus and orthotropia. We report a patient with a 48-h cycle of esohypotropia associated with axial high myopia that resolved by Yokoyama procedure.Case presentationA 43-year-old female patient who underwent left medial rectus muscle recession and lateral rectus muscle resection elsewhere due to highly myopic strabismus 2 years ago. The patient experienced a recurrence of left esohypotropia 12 months after undergoing surgery, exhibiting a 48-hour cycle. The cycle is one full day of esohypotropia and one day of orthotropia. The patient exhibited a case of high myopia in the left eye, characterized by a diopter measurement of -24.00DS and an eye axis measurement of 28.43 mm. Orbital CT showed supertemporal dislocation of the posterior portion of the elongated globe out from the muscle cone. Based on these observations, we performed Yokoyama procedure by uniting the muscle bellies of the superior rectus(SR) and lateral rectus (LR) muscles to restoring the dislocated globe back into the muscle cone.ConclusionsWhen cyclic strabismus is combined with axial high myopia, the Yokoyama procedure was effective and cycles are successfully terminated without overcorrection on no squint days. The purpose of this procedure is to put the dislocated globe back into its muscle cone by uniting the muscle bellies of the superior rectus and lateral rectus.

Analysis of postoperative exodrift according to surgical methods for intermittent exotropia.

This study aimed to compare the periods for exodrift stabilization and the long-term surgical outcomes among different surgical methods in intermittent exotropia. The medical records of 350 patients who had undergone intermittent exotropia correcting surgery [unilateral lateral rectus recession-medial rectus resection (R&R, n = 221), bilateral lateral rectus recession (BLR, n = 51) and unilateral lateral rectus recession (ULR, n = 78)] with a postoperative follow-up period of 1.5 years or more were retrospectively reviewed. The deviation angles every 6 months after surgery, periods of exodrift stabilization and surgical outcomes were analysed. The period of postoperative exodrift stabilization was defined as when exodrift was no longer significantly different from that at the next visit (p > 0.05). An alignment of 5 PD (prism diopters) esotropia to 10 PD exotropia at a distance and near fixation was considered surgical success. The mean angle of exodeviation was significantly different among surgical procedures at postoperative 1 month (BLR > ULR > R&R, p < 0.001); however, there were no differences among the procedures at 6 months (p = 0.088). The periods of exodrift stabilization were 6 months after ULR, 1 year after BLR and 4.5 years after R&R. The surgical success and reoperation rates did not show significant differences among procedures at the final follow-up. Patients undergoing R&R showed smaller exodeviation shortly after surgery but required a longer period to stabilize the exodrift. Following ULR, exodeviation was larger in the early postoperative period, but the exodrift was stabilized earlier. Therefore, the long-term surgical outcomes were similar among ULR, BLR and R&R.

Augmented-Dose Unilateral Recession-Resection Procedure in Acute Acquired Comitant Esotropia

To compare the surgical amount of unilateral recession-resection (RR) procedure in patients with acute acquired comitant esotropia (AACE) versus common forms of esotropia (ET), and to provide dose-response reference for surgical planning in AACE. Retrospective study. Consecutive patients who underwent unilateral RR for AACE or ET correction from January 2018 to January 2022. Only patients achieved motor (residual deviation <5 prism diopters [Δ] in primary position) and sensory (elimination of diplopia in primary position and for reading) success with a minimum follow-up of 3 months were analyzed. Group difference in the amount of medial rectus recession (MRrec) and lateral rectus resection (LRres) was analyzed using multivariate regression models. Moreover, surgical dose-responses in the AACE group were analyzed using multivariable regression models. Regression models were performed with and without adjustment for clinical confounders. Piecewise analysis was used to detect segmented results. Group difference in surgical amount of MRrec and LRres, as well as dose-responses of unilateral RR in AACE patients with different-sized deviations. 54 AACE patients and 98 ET patients were included. Compared with the ET group, surgical amount performed was significantly larger in the AACE group to achieve a comparable effect of deviation correction. The adjusted group difference was 0.49 mm (95%CI=0.34-0.65; P<0.001) in MRrec and 1.68 mm (95%CI=1.25-2.11; P<0.001) in LRres in patients with horizontal deviation <40Δ; while only a mean difference of 1.22 mm (95%CI=0.76-1.6871; P<0.001) in LRres was found in those with deviation ≥40Δ. In the second part, dose-response analysis in AACE patients was performed with a determined cutoff deviation of 30Δ. In patients with deviation <30Δ, the adjusted dose-responses of MRrec and LRres were 5.11Δ/mm (95%CI=0.98-9.23; P=0.02) and 2.51Δ/mm (95%CI=0.57-4.45; P=0.02), respectively; while for those with deviation ≥30Δ, the adjusted dose-response of additional LRres was 5.48Δ/mm (95%CI=4.56-6.40; P<0.001) to correct the remaining deviation above 30Δ. These findings provide quantitative evidence that augmented-dosed unilateral RR should be performed in AACE for favorable surgical outcomes. The new surgical dose calculation proposed provide reference for surgical planning.

Comparison of Unilateral and Bilateral Surgical Approaches for the Treatment of Age-Related Divergence Insufficiency Esotropia

ABSTRACT Purpose Age-related divergence insufficiency-esotropia (ARDIE) is characterized by greater esodeviation at distance than near. This study aims to compare the outcomes of unilateral and bilateral surgical approaches. Patients and Methods Sixty-two cases treated at the Kellogg Eye Center, the University of Michigan, from 1995 to 2018 were retrospectively reviewed. One surgeon used unilateral procedures including unilateral medial rectus recession (n = 24, group 1) or unilateral recession-resection (n = 18, group 2) with an adjustable suture. Another surgeon used bilateral medial rectus recession with fixed sutures (n = 20, group 3). Results For patients with distance esodeviation <15∆, postoperative distance deviations in both group 1 and group 3 were not statistically different (p = .352). For patients with esodeviations 15–20∆, postoperative distance deviations in all 3 groups were also not statistically different (p = .142). Similarly, patients with deviations >20∆ did not show significantly different postoperative distance alignment (p = .082) between group 2 and 3. Overall, group 2 had the highest overall success rate (90%) (mean at distance = 1.17∆ exodeviation, at near = 2.33∆ exodeviation). Conclusion Both unilateral medial rectus recession ± lateral rectus resection and bilateral medial rectus recession surgical approaches produced similar favorable outcomes in ARDIE.

Outcomes of Bilateral Lateral Rectus Resection in Residual Esotropia following Bilateral Medial Rectus Recession.

Purpose:To evaluate the success rate, dose-response ratio, and predictive factors of success in patients with residual esotropia (≥25 prism diopter [pd]) following bilateral medial rectus (BMR) recession who underwent bilateral lateral rectus (BLR) resection.Methods:In a retrospective study, medical records were reviewed for 47 patients with equal or more than 25 pd residual esotropia following 6 mm BMR recession. Sex, age at second surgery, the interval between first and second surgery in months, visual acuity, refraction, presence of amblyopia, presence of dissociated vertical deviation or inferior oblique overaction/superior oblique overaction, preoperative and postoperative angle of deviation, amount of BLR resection, and months of follow-up were evaluated. Surgical success was defined as postoperative deviation within 8 pd of orthophoria.Results:The mean age of patients at reoperation was 48.59 ± 21.46 months. The mean near and far residual esotropia before BLR resection was 34.57 ± 11.02 and 33.83 ± 10.99 pd, respectively, reduced to 8.12 ± 1.43 pd in near and 6.32 ± 2.1 pd in far postoperatively. The mean BLR resection dosage was 5.53 ± 1.22 mm and each millimeter of BLR resection (1 mm for each eye) corrected an average of 7.95 pd of deviation in near and 7.40 pd in far. The success rate was 74.5%. After analysis using multivariate logistic regression, there were no factors associated with success.Conclusions:Bilateral rectus resection in patients with a previous BMR recession has acceptable outcomes. The recommended surgical table can be used as a guide by strabismus surgeons in patients with residual esotropia.

Supramaximal Horizontal Rectus Recession–Resection Surgery for Complete Unilateral Abducens Nerve Palsy

PurposeTo review the surgical procedures and outcomes of supramaximal horizontal rectus recession–resection surgery for abduction deficiency and esotropia resulting from complete unilateral abducens nerve palsy.MethodsA total of 36 consecutive cases diagnosed as complete abducens nerve palsy, receiving supramaximal medial rectus recession (8.5 ± 1.4 mm, range: 6–10) combined with a supramaximal lateral rectus resection (11.1 ± 1.7 mm, range: 8–14) as performed over the period from 2017 to 2020, were reviewed retrospectively. All surgeries were performed by a single surgeon. Pre- and post-operative ocular motility, ocular alignment, forced duction test, binocular vision, abnormal head posture, and surgical complications were assessed.ResultsOf these 36 cases, 23 (63.8%) were followed up for greater than 2 months (Mean ± SD = 8.4 ± 6.0, range: 2–24) after surgery and the collected data was presented. Mean ± SD age of these patients was 41.7 ± 14.4 (range: 12–67) years with 73.9% being female. Trauma (52.2%, 12/23) and cerebral lesions (21.7%, 5/23) were the primary etiologies for this condition. Esodeviation in primary position improved from 55.5 ± 27.2 prism diopters (PD) (range: +25 to +123) to 0.04 ± 7.3 PD (range: −18 to +12) as assessed on their last visit. Pre-operative abduction deficits of −5.6 ± 1.0 (range: −8 to −4) reduced to −2.4 ± 1.4 (range: −4 to 0) post-operatively. The mean dose-effect coefficient of 2.80 ± 1.20 PD/mm (range: 1.07–6.05) was positively correlated with pre-operative esodeviation. Rates of overcorrection and ortho were 69.6 and 26.1%, respectively, on the first day after surgery, while on their last visit the respective levels were 4.3 and 82.6%.ConclusionSupramaximal horizontal rectus recession–resection surgery is an effective treatment method for complete abduction deficiency. The dose-effect was positively correlated with pre-operative esodeviation. Overcorrection on the first day post-operatively is required for a long-term satisfactory surgical outcome.

Efficacy of medial rectus plication versus resection for exotropia: a meta-analysis.

To compare the outcomes of medial rectus plication and medial rectus resection procedures in the treatment of exotropia. Articles from Pubmed, EMBASE, Web of Science, and Cochrane Library databases until July 2021 with a minimum follow-up period of 1month were retrieved. No restriction on language was applied. Eligible studies must comply with the inclusion criteria. Only studies with comparisons between unilateral medial rectus plication versus unilateral medial rectus resection, unilateral lateral rectus recession-medial rectus plication (RP) versus unilateral lateral rectus recession-medial rectus resection (RR), or bilateral medial rectus plication(BMRP) versus bilateral medial rectus resection (BMRR) would be included for subsequent analysis. Two primary outcomes were specified: success rate and mean postoperative deviation. Dichotomous data were calculated as pooled odds ratios (ORs) with 95% confidence intervals (CIs) and continuous data as weighted mean differences (WMD) with 95% CIs. A total of 8 studies with 557 participants were enrolled in the meta-analysis based on the inclusion criteria. Seven studies compared lateral rectus recession + medial rectus plication to unilateral lateral rectus recession + medial rectus resection and one study compared bilateral medial rectus plication to bilateral medial rectus resection. Differences in success rates between plication and resection groups were not statistically significant (OR = 0.66; 95% CI, 0.43-1.02; P = 0.06), and the unsatisfactory effects (the undercorrection and overcorrection rates) between the two groups were comparable. Additionally, there were also no significant differences in postoperative deviation and the amount of exodrift between the two groups. This meta-analysis provides evidence that both the medial rectus plication and medial rectus resection procedures have similar efficacy in the treatment of exotropia.

Outcome of Strabismus Surgery for Exotropia in a 4-year-old with Silver-Russell Syndrome (SRS): A Case Report

Silver-Russell Syndrome (SRS) is a rare disorder associated with prenatal and postnatal growth retardation with associated characteristic facial and ocular features including strabismus. We report the outcome of strabismus surgery performed for exotropia in a 4-year-old patient with SRS. The patient presented with decreased visual acuity and constant exotropia of the right eye noted since 3 months of age. Systemic SRS characteristics consisted of relative macrocephaly, short stature, forehead prominence and stunted growth pattern. An X-pattern exotropia is consistent with bilateral tight lateral recti muscles with over-elevation in adduction of the left eye was present. Patient underwent unilateral right lateral rectus recession and right medial rectus resection for a 50-prism diopter constant exotropia. Patient had a favorable outcome of within 8 prism diopters from orthotropia at 1st, 3rd-, 6th- and 12th-month post-operatively.

Surgical success of lateral rectus resection for residual and recurrent esotropia.

To assess the surgical outcomes of reoperations for residual and recurrent esotropia. A retrospective chart review of all patients who underwent surgery during 2000-2017 at a tertiary referral medical center for recurrent or residual esotropia was conducted. Patients who underwent bilateral medial rectus recession as primary surgery and lateral rectus resection as second surgery were included. The success rate of second surgery and its association to various factors were examined. Success of reoperation was defined as mean deviation of < 10 prism diopters (= PD) at last follow-up. Twenty-seven patients with mean post-operative follow-up of 50.4 ± 31.7months were included. On last follow-up examination, 15 (55.6%) patients had a successful reoperation and 12 (44.4%) patients had unsuccessful reoperation. The two groups were similar in the pre-operative amount of esotropia for distance and near. On last follow-up examination, the amount of mean deviation was 1.9 PD esotropia (8 PD exotropia to 9 PD esotropia) in the success group and 11.2 PD esotropia (22.5 PD exotropia to 35 PD esotropia) in the failure group. In the failure group, 75.0% of patients were under-corrected (esotropia of ≥ 10 PD) on last follow-up examination. Strabismus reoperation in cases of residual or recurrent esotropia was successful in slightly more than half of the patients. Surgical failure was more commonly associated with undercorrection and less with overcorrection.

Lateral rectus muscle differentiation potential in paralytic esotropia patients

Purpose and backgroundRecently, we found that maximal medial rectus recession and lateral rectus resection in patients with complete lateral rectus paralysis resulted in a partial restoration of abduction. In an attempt to understand some of the mechanisms involved with this effect we examined gene expression profiles of lateral recti from these patients, with our focus being directed to genes related to myogenesis.Materials and methodsLateral recti resected from patients with complete lateral rectus paralysis and those from concomitant esotropia (controls) were collected. Differences in gene expression profiles between these two groups were examined using microarray analysis and quantitative Reverse-transcription PCR (qRT-PCR).ResultsA total of 3056 differentially expressed genes (DEGs) were identified between these two groups. Within the paralytic esotropia group, 2081 genes were up-regulated and 975 down-regulated. The results of RT-PCR revealed that PAX7, MYOG, PITX1, SIX1 and SIX4 showed higher levels of expression, while that of MYOD a lower level of expression within the paralytic esotropia group as compared with that in the control group (p < 0.05).ConclusionThe decreased expression of MYOD in the paralytic esotropia group suggested that extraocular muscle satellite cell (EOMSCs) differentiation processes were inhibited. Whereas the high expression levels of PAX7, SIX1/4 and MYOG, suggested that the EOMSCs were showing an effective potential for differentiation. The stimulation resulting from muscle surgery may induce EOMSCs to differentiate and thus restore abduction function.

Strabismus Surgery Outcomes and Their Determinants in Patients with Chronic Sixth Nerve Palsy.

PURPOSE:Patients with chronic sixth nerve palsy (CSNP) comprise a heterogeneous population, and the optimal surgical solution remains uncertain. Here, we present the success rate and factors associated with the success of strabismus surgeries for CSNP.METHODS:This was a retrospective cohort study of patients with strabismus due to CSNP operated on between 2015 and 2019 in a tertiary eye hospital in central Saudi Arabia. Surgical success was defined as a horizontal deviation of ≤10 prism diopters (PDs) assessed at least 12 months after surgery. Differences between groups with respect to the primary outcome were assessed.RESULTS:Fifty-five patients were analyzed with a median follow-up of 24 (range 12–48) months. Superior rectus and inferior rectus transposition (34.5%) and medial rectus recession with lateral rectus resection (32.7%) were the main surgeries performed. The overall success rate was 67.3% (95% confidence interval 54.9–79.7). Bilateral CSNP (P = 0.05), a higher preoperative angle of deviation (P = 0.002), or a greater degree of preoperative limitation of abduction (P = 0.012), but not the type of surgery (P = 0.09), were more likely to result in an under-corrected outcome of >10 PD. The preoperative deviation angle showed a trend toward being associated with a poor outcome after surgery (P = 0.06). Six patients with high-angle deviation before surgery required second surgery.CONCLUSION:While the surgical procedure does not impact outcomes, the severity of preoperative horizontal deviation might impact surgical success and the need for reoperation. Patients with severe CSNP should be counseled appropriately about the chances of surgical success and the potential need for further interventions.

Longitudinal course of consecutive esotropia in children following surgery for basic-type intermittent exotropia.

To evaluate the longitudinal course of consecutive esotropia following surgery for basic-type intermittent exotropia. Patients who underwent surgery (bilateral lateral rectus muscle recession [BLR] or unilateral lateral rectus muscle recession-medial rectus muscle resection [RR]) for the treatment of intermittent exotropia between 2011 and 2017 with a minimum follow-up period of 2 years were retrospectively reviewed. When esodeviation occurred later in patients with orthotropia or exodeviation at postoperative month 1, it was defined as delayed-onset consecutive esotropia. The number of patients with esodeviation at every follow-up and characteristics of patients were evaluated. A total of 336 patients (6.2 ± 2.1 years; 236 in the BLR group and 100 in the RR group) were included. After surgery, postoperative esodeviation decreased mostly during the 1st postoperative month in both groups. At postoperative year 2, there were 28 patients (8.3%) with consecutive esotropia: six in the RR group and 22 in the BLR group. Among the 284 patients with orthotropia or exodeviation at postoperative month 1, there were 13 patients with delayed-onset consecutive esotropia; they presented larger preoperative angle of exodeviation, poorer stereopsis, younger at the time of surgery and associated with the types of surgeries for exotropia. In patients with consecutive esotropia, the angle of esodeviation decreased and patching/prismatic correction helped achieve the good surgical outcomes. However, delayed-onset consecutive esotropia and persistent esotropia also presented, requiring the reoperation. Therefore, postoperative alignment should be carefully monitored after surgery for intermittent exotropia.

Surgical Outcomes of Medial Rectus Recession and Lateral Rectus Resection for Large-angle Deviations of Acute Acquired Concomitant Esotropia.

PurposeThis study aimed to evaluate the surgical outcomes of unilateral medial rectus recession and lateral rectus resection (R&R) for patients with large-angle deviations of acute acquired concomitant esotropia (AACE) without a neurological disease. Further, we have also suggested the surgical dosage of R&R for large-angle deviations of AACE.MethodsThis was a retrospective study of patients with AACE who underwent surgery and followed up after surgery for at least 6 months between September 2016 and March 2020. Among them, patients with ocular deviations of ≥30 prism diopters (PD) who underwent unilateral R&R were included.ResultsSeventeen patients with AACE were enrolled in this study (mean age, 23.5 years; four females). The mean amount of deviation was 40.00 PD at distance and near (range, 30–55 PD). Fifteen patients (88.2%) had myopia. The mean interval between the initial visit and surgery was 7.7 months (range, 4–20 months). All included patients had resolved diplopia after the surgery. Most patients with decreased stereoacuity displayed stereoacuity recovery after surgical treatment. At the final visit (mean follow-up period, 12.8 months), the mean angle of esodeviation was 0.82 PD (range, 6–0 PD) at distance and 0.47 PD (range, 4–0 PD) near. No patient displayed over-correction or adduction limitations in the operated eye.ConclusionsThe unilateral R&R procedure presented favorable surgical outcomes for patients with large-angle deviations of AACE. These results and proposed surgical dosage guidelines may be useful for surgeons in planning the surgical treatment of large-angle deviations of AACE.

Effect of lateral rectus muscle resection on abduction in Duane retraction syndrome type 1.

To assess the effect of lateral rectus muscle resection on abduction in Duane retraction syndrome (DRS) type 1. The medical records of patients with DRS type 1 were reviewed retrospectively. Fifteen patients who underwent lateral rectus resection were included. Prism and cover test and the Krimsky test were used to detect deviations. Ocular ductions, abnormal head position (AHP), and globe retraction were recorded. Nine (60.0%) patients were female. The mean age was 13.1 ± 2.3 (range, 2-34) years. Left eyes were included in ten (66.7%) patients. Mean follow-up time was 37.6 ± 16.6 (range, 6-70) months. All patients had AHP, 13 patients had mild globe retraction, and 2 patients had no globe retraction preoperatively. Mean lateral rectus resection was 3.1 ± 0.7 (range, 2.0-4.5) mm, and the mean medial rectus recession was 4.4 ± 0.6 (range, 3.0-5.0) mm. The mean preoperative deviation decreased from 23.3 ± 6.9 (range, 14-35) prism diopters (pd) to 2.2 ± 4.1 (range, 0-10) pd at near, and from 23.6 ± 7.1 (range, 14-35) pd to 1.8 ± 3.5 (range, 0-10) pd at distance, at 6months postoperatively (p = 0.01). The mean limitation in abduction decreased from -3.2 ± 0.9 to -1.3 ± 1.1 postoperatively (p < 0.001). AHP resolved in all patients. There was not a limitation in adduction or a worsening of globe retraction in any patient. Lateral rectus resection can be used to improve abduction in patients with DRS type 1 who have mild globe retraction. We assume that this procedure has no worsening effect on globe retraction in appropriate cases.