Medial Rectus Resection Research Articles

Early Onset Sixth-Nerve Palsy with Eccentric Fixation

ABSTRACTPurpose: To report four cases of early onset sixth-nerve palsy all of whom had eccentric fixation.Methods: A retrospective case note review was undertaken of all cases presenting to the senior author's private and NHS practice with early onset sixth palsy between 2006 and 2012. As well as demographic information, details of ophthalmic, orthoptic, electrophysiological examinations, and radiological investigations that were extracted from the records.Results: Four children with unilateral or asymmetric early onset sixth-nerve palsy were identified, of which three were congenital. All four had MRI and only one had a normal MRI. Age at presentation ranged from 14–42 months, but all four had marked esotropia and poor visual acuities in the worst affected eye with eccentric fixation, which became more easily or only noticeable after surgical correction. Three patients with congenital sixth-nerve palsy underwent vertical muscle transposition with Botulinum Toxin A(BTXA) to the ipsilateral medial rectus, and two of these patients also had Foster sutures to the transposed vertical muscles. The fourth patient had unilateral medial rectus recession and lateral rectus resection. The mean preoperative measurement was 55Δ ET (range 50–60Δ), and the mean postoperative measurement was 11Δ ET (range 16XT-25ET) at near, and 2Δ XT (range 15XT-14ET) at distance.Conclusions: We speculate that early onset paralytic strabismus due to congenital sixth-nerve palsy results in an inability to cross fixate which results in the development of eccentric fixation. Attempts to use reverse occlusion to negate the eccentric fixation failed. We therefore recommend early surgery for this condition to avoid this sequelae.

A Valid Indication and the Effect of Bilateral Inferior Oblique Transposition on Recurrent or Consecutive Horizontal Deviation in Infantile Strabismus.

PurposeTo evaluate the effects of bilateral inferior oblique transposition (BIOT) on horizontal deviation from primary position among patients with bilateral dissociated vertical deviation (DVD) associated with inferior oblique overaction (IOOA) in infantile strabismus.MethodsRetrospective chart review was conducted among 19 patients with infantile strabismus. All patients had DVD and IOOA with consecutive or recurrent horizontal deviation and underwent modified BIOT surgery. Patients were divided into three subgroups: patients who underwent BIOT (BIOT group, n = 9) alone, BIOT with medial rectus recession or lateral rectus resection simultaneously (ET BIOT group, n = 6), or BIOT with lateral rectus recession or medial rectus resection simultaneously (XT BIOT group, n = 4). Postoperative angle of horizontal deviation (prism diopter, PD) and corrected magnitude of horizontal deviation (PD) at final visit after surgery were analyzed in each group.ResultsThe mean age was 55.11 ± 21.05 months (range, 32 to 115). The mean follow-up period was 8.68 ± 2.87 months (range, 6 to 18). Preoperative horizontal deviation was 4.23 ± 5.99 PD (range, 0 to 16) in BIOT, −17.33 ± 6.76 PD (range, −30 to −10) in ET BIOT, and 17.50 ± 2.52 PD (range, 14 to 20) in XT BIOT. Esodeviation is represented by negative values. DVD and IOOA were reduced less than +1 in all patients. The corrected amount of horizontal deviation was 3.56 ± 5.18 PD (range, 0 to 16) in BIOT surgery alone and larger in XT BIOT (18.50 ± 3.41 PD) than in ET BIOT (12.33 ± 5.57 PD, p = 0.004).ConclusionsMinimal exodeviation was corrected by BIOT alone. In addition, secondary eso- or exodeviation at great magnitudes should be corrected with proper horizontal muscle surgery along with BIOT.

Adjustable surgical treatment of adult exotropia: postoperative target angles and surgical success

ObjectivesThis study had 3 objectives: (i) to characterize clinical profiles of adults with consecutive exotropia (CXT), intermittent exotropia (IXT), and sensory exotropia (SXT); (ii) to correlate immediate postoperative target angles with successful long-term ocular alignment; and (iii) to compare the efficacy of adjustable versus nonadjustable medial rectus resection ± advancement. Study DesignRetrospective, observational, and interventional cohort study. ParticipantsA total of 133 adult exotropic patients treated surgically at 3 different hospitals between July 2012 and June 2013. MethodsThe patients were divided according to clinical profiles (CXT, IXT, and SXT) based on ophthalmic and orthoptic assessments. Two treatment groups were established: group I—adjustable medial rectus resection ± advancement and adjustable lateral rectus recession; group II—nonadjustable medial resection ± advancement and adjustable lateral rectus recession. Measurements of immediate postadjustment alignment (target angle) and 4–6 months of follow-up alignment were performed and compared between groups. Surgical success was defined as distance primary position alignment within 10 prism diopters (PD) of orthotropia 4–6 months postoperatively. ResultsComparison of clinical profile groups showed that CXT patients had more hyperopia and amblyopia and smaller preoperative deviations; IXT patients had more diplopia and larger preoperative deviations (near > distance); and SXT patients had poor vision in the deviating eye and larger preoperative deviations. Immediate postoperative alignment was 5.2 PD of esodeviation in group I and 3.2 PD of esodeviation in group II. Overall success rates for ocular alignment at 4–6 months postoperatively were comparable with both surgical techniques (74.6% for group I and 74.3% for group II). Patients with a preoperative deviation ≥40 PD had a lower surgical success rate (63.8%) than patients with a deviation <40 PD (80%). Patients presenting with a significant (−1 or worse) abduction deficit in the operated eye at their first visit after surgery had a better success rate at 4–6 months’ follow-up (83.3% vs 67.8%). ConclusionsAdjustable and nonadjustable medial rectus surgeries seem equally successful. Creation of an abduction deficit in the early postoperative period seems predictive of a better outcome. Larger preoperative angles (≥40 PD) were associated with more exotropic drift and a lower percentage of surgical success. Future studies will continue to search for surgical strategies and the ideal target angle that will produce the best long-term alignment stability.

Outcome of two-muscle surgery for large-angle intermittent exotropia in children

Background/aimsTo evaluate the surgical outcomes of two-muscle surgery for childhood intermittent exotropia comparing large angles with moderate angles.MethodsWe retrospectively reviewed the medical records of 178 children who had undergone bilateral...

Therapeutic evaluation of lateral rectus super-recession surgery for large angle divergence excess exotropia

Background In clinic practice, three or four rectus muscles often are needed to perform operation for the correction of large angle (>50△) exotropia to avoid eye limited abduction due to lateral rectus super-recession.However, recent study reported that lateral rectus super-recession surgery can effectively correct large angle exotropia without remarkable abduction limitation.This outcome still need to be verified in clinical practice. Objective This study was to observe the outcome of bilateral rectus super-recession or medial rectus resection of the combined non-dominant eye for large angle exotropia. Methods A series case study was carried out.Fifty-one patients with intermittent or constant exotropia were enrolled in Tianjin Eye Hospital from May 2013 to October 2014.There were 29 intermittent exotropia and 22 constant exotropia among the 51 patients.Combined with adjustable sutures, bilateral lateral rectus super-recession or medial rectus resection of combined non-dominant eye was performed in all the eyes, and the examination of the anterior segment, fundus, ocular movement and binocular vision were performed before and after surgery.The deviation angle was measured by prism and alternate cover test.The individualized surgery procedure was designed according to medical history, ocular movement, sensory status and deviation angle.The patients were followed-up for at least 6 months.The eye position, ocular movement and binocular sensory function were compared between peoperation and postoperation.This study was approved by the Ethics Committee of Tianjin Eye Hospital.Written informed consents before the operation were obtained from all patient or their parents. Results Thirty-three patients underwent bilateral lateral super-recession and 18 patients underwent bilateral lateral super-recession of the medial rectus resection of the combined non-dominant eye.The mean angle of exotropia for seeing distance of 5 meters was (-70.57±16.46)△(from -52△to -120△) and was (-75.65±16.14)△for seeing near (33 cm) (from -55△to -130△). The mean amount of left eye recession was 8-15 mm ([11.17±1.67]mm) and the right eye recession was 9-15 mm ([11.28±1.62]mm). The medial rectus of the dominant eye was resected by 3-6 mm.At the end of following-up, the mean angle of exotropia for seeing distance was (-3.45±4.20)△(from + 4△to -14△) and was (-5.49±3.96)△for seeing near (from + 4△to -14△). Surgical outcome was effective in 41 patients (80.4%), and 10 patients were undercorrected.The stereopsis of 32 patients improved after surgery, and 18 of 27 patients without preoperative stereopsis function obtained stereopsis after surgery.No ocular motility disorder was found in this group of patients after surgery. Conclusions Bilateral lateral rectus super-recesssion or medial rectus resection of combined non-dominant eye can effectively correct large angle exotropia and reduce the number and amount of surgical muscles without ocular motility disorder. Key words: Ophthalmologic surgical procedure; Exotropia/surgery; Oculomotor muscles/surgery; Treatment outcome; Vision, binocular; Lateral rectus recession; Super-recession; Large angle divergence excess exotropia

A New Surgical Treatment Option for Chronic Total Oculomotor Nerve Palsy: A Modified Technique for Medial Transposition of Split Lateral Rectus Muscle.

To describe a new surgical modified procedure in patients with chronic total oculomotor nerve palsy and to evaluate the results of this procedure. Eight eyes of 6 consecutive patients who underwent strabismus surgery due to chronic total oculomotor nerve palsy were enrolled in the study. The lateral rectus muscle was split into two halves and disinserted from the sclera. The upper half of the muscle was passed under the superior rectus muscle and the inferior half of the muscle was passed under the inferior rectus muscle. The two halves of the muscle were moved to the medial rectus muscle insertion area and were sutured to sclera near the insertion. Additional medial rectus resections were made in the undercorrected patients. The mean age was 21.8 ± 12.1 years (range: 11 to 42 years). Postoperatively, 4 of 6 patients had stable horizontal deviations; 1 had orthophoria, 2 had 10 prism diopters (PD) of exotropia, and 1 had 10 PD of esotropia. However, 2 cases had 25 and 30 PD of undercorrection. Additional medial rectus resections were made in these undercorrected patients and horizontal deviations reduced to 15 and 20 PD of exotropia, respectively. The mean primary position horizontal deviation, which was 74.1 ± 10.2 PD before the surgeries, reduced to 10.8 ± 6.6 PD after the surgeries (P < .001). The authors described a new and relatively simple modified surgical procedure for the treatment of chronic total ocular nerve palsy and reached satisfactory outcomes. Further studies with larger sample sizes are warranted. [J Pediatr Ophthalmol Strabismus. 2016;53(3):150-154.].

Clinical Characteristics and Surgical Outcomes in Patients With Intermittent Exotropia: A Large Sample Study in South China.

The clinical characteristics and surgical outcomes in a large sample of patients with intermittent exotropia (IXT) as well as an analysis of risk factors associated with surgical failures are presented in this article. Data from IXT patients who received surgical management at the Eye Hospital, in the Zhongshan Ophthalmic Center, of Sun Yat-Sen University, China from January 2009 to December 2013 were reviewed retrospectively. Included within this analysis were data from pre- and postoperative ocular motility, primary alignment, and binocular vision.A total of 1228 patients with IXT were reviewed. Males (50.4%) and females (49.6%) were nearly equally represented in this sample. Thirty-two patients (2.6%) had a family history of strabismus. The mean age at onset was 6.77 ± 6.43 years (range 7 months –48.5 years), mean duration at presentation was 7.35 ± 6.68 years (range 6 months–47 years), and mean age at surgery was 13.7 ± 8.8 years (range 3–49 years). The mean refractive error was −0.84 ± 2.69 diopter in the right eye and −0.72 ± 2.58 diopter in the left eye. Amblyopia (4.2%), oblique muscle dysfunction (7.0%), and dissociated vertical deviation (4.7%) were also present in these patients. The most common subtype of IXT was the basic type (88.1%). Orthophoria was observed in 80.5% of patients and the ratios of surgical undercorrection and overcorrection were 14.7% and 4.8%, respectively, as determined with a mean follow-up time of 7.8 ± 3.7 months. When combining ocular alignment with binocular vision as the success criteria, the success rate decreased to 35.6%. Multivariate risk factor analysis showed that only the loss of stereoacuity (P = 0.002) was associated with a poor outcome. There were no differences in the long-term results between bilateral lateral rectus recession and unilateral lateral rectus recession with medial rectus resection.Most IXT patients displayed normal vision, with few having positive family histories, amblyopia, oblique muscle dysfunction, and dissociated vertical deviation. The most common subtype of IXT was the basic type. Long-term surgical results were less favorable when sensory status was included in the criteria for success. Patients with stereoacuity loss were at an increased risk for poor outcomes.

Long-Term Results of Symmetrical and Asymmetrical Surgery for Basic-type Intermittent Exotropia in Turkish Patient

Aim: To evaluate the long-term results of symmetrical (i.e., bilateral lateral rectus recession) (BLR rec) and asymmetrical (i.e., unilateral medial rectus resection and lateral rectus recession) (R-R) surgical treatment of patients with a diagnosis of basic-type intermittent exotropia (X(T)). Methods: The patient folders of a total of 65 patients with basic-type X(T) who visited the Ankara Ulucanlar Eye Education and Research Hospital Eye Clinic Strabismus Unit between January 2004 and January 2013 and underwent strabismus surgery were analyzed retrospectively. The patients were evaluated according to the applied surgical method: patients treated using the BLR rec method (Group 1= 25) and patients treated using the R-R method (Group 2= 40). During the last Original Research Article

Consecutive Exotropia after Convergent Strabismus Surgery—Surgical Treatment

Purpose: In this study the results of consecutive exotropia surgical treatment by using different surgical technics are presented. Methods: This study included 34 patients, aged 21 to 47 years (mean 27.9), who underwent medial rectus muscle advancement alone or in combination with medial rectus resection and/or lateral rectus recession. The mean interval between original surgery and surgery for consecutive exotropia was 8.5 years (range: 5.5 years to 14 years). Most of patients had 2 and more prior surgeries (73.5%) sold by an adduction deficit (47.06%). Results: The overall mean preoperative exodeviation was 35.12 ± 10.13 PD. Satisfactory alignment (within 10 PD of orthophoria) was achieved in 20 patients (58.8%) at 10 days after surgery and 24 patients (70.5%) at final 6-month follow-up. The most common surgical procedures were unilateral MR advancement and LR recession—47%. Conclusion: Medial rectus advancement is an effective method of surgical treatment, especially in cases with adduction limitation, but the risk of the eyelid fissure narrowing in cases of MRM advancement more than 5 mm associated with resection is present. In our opinion for reducing this risk in cases of XT with big angle of deviation, performing a smaller amount of advancement associated with recession of LRM can prevent the development of a such complication.

The Stabilization of Postoperative Exo-drift in Intermittent Exotropia after Surgical Treatment.

PurposeTo investigate the long-term clinical course of intermittent exotropia after surgical treatment to determine whether and when postoperative exo-drift stabilizes, and the required postsurgery follow-up duration in cases of intermittent exotropia.MethodsWe retrospectively reviewed the medical records of patients diagnosed with intermittent exotropia who underwent surgical treatment between January 1992 and January 2006 at Yeungnam University Hospital and postoperatively performed regular follow-up examinations for up to 7 years. We also analyzed the difference in exo-drift stabilization, according to surgical procedure.ResultsA total of 101 patients were enrolled in the study. Thirty-one patients underwent lateral rectus recession and medial rectus resection (R&R) and 70 patients underwent bilateral lateral rectus recession (BLR). The postoperative angles of deviation increased significantly during the initial 36 months, but no subsequent significant changes were observed for up to 84 months. Follow-ups for 7 years revealed that more than 50% of the total amount of exo-drift was observed within the first postoperative year. In addition, the angles of deviation at 1 year correlated with those at 7 years postoperatively (Pearson correlation coefficient r = 0.517, p < 0.001). No significant exo-drift was observed after 36 months in patients who underwent BLR, whereas after 18 months in patients who underwent R&R.ConclusionsThe minimum postoperative follow-up required after surgical treatment to ensure stable results is 36 months. In particular, careful follow-up is necessary during the first postoperative year to detect rapid exo-drift. Patients who underwent BLR required a longer follow-up than those who underwent R&R to ensure stable postoperative alignment.

Surgical Correction of Consecutive Esotropia With Unilateral Medial Rectus Recession.

Unilateral medial rectus recession is a treatment option to surgically correct consecutive esotropia. This study evaluated the surgical outcomes of patients who underwent unilateral medial rectus recession for the treatment of consecutive esotropia after surgery for intermittent exotropia. The medical records of 16 patients who underwent surgical correction of consecutive esotropia with unilateral medial rectus recession were retrospectively reviewed. Patients with intermittent exotropia who were previously treated with one or multiple surgical procedures (8 bilateral lateral rectus recession, 7 recess-resect procedure, or 1 bilateral medial rectus resection) were included in the study. Three patients were adults and 13 patients were children. The mean age was 5 years for children and 50.3 years for adults. Consecutive esotropia was defined as residual manifest esodeviation of 10 prism diopters (PD) at 6 months postoperatively. Successful correction of consecutive esotropia was defined as the lack of manifest or intermittent tropia and esophoria/exophoria within 8 PD. Patients with monofixational exotropia were excluded from the study. Unilateral medial rectus recession was successful in the correction of consecutive esotropia in 10 of 16 cases (62.5%). Six of 16 (37.5%) patients had unsatisfactory postoperative alignment, with 5 patients showing recurrence of exotropia. Only one patient was undercorrected. The success rate of surgical correction of consecutive esotropia with single muscle surgery was good. Recurrence of exotropia accounted for most of the failures, and all recurrences occurred in the group of patients initially treated surgically for intermittent exotropia with a recess-resect procedure.

Comparison of Lateral Rectus Muscle Re-recession and Medial Rectus Muscle Resection for Treatment of Postoperative Exotropia

To compare the outcomes of unilateral lateral rectus muscle re-recession and medial rectus muscle resection for treatment of recurrent or persistent exotropia. Retrospective nonrandomized clinical trial. setting: Hospital-based clinical practice. Forty patients with recurrent or persistent exotropia following bilateral lateral rectus muscle recessions. Fourteen patients were treated with unilateral medial rectus muscle resection and 26 with unilateral lateral rectus muscle re-recession. Outcomes were considered successful if the patients had deviations less than 10 prism diopters (PD) at last follow-up. All patients were followed for at least 1 year postoperatively. The mean preoperative deviations were 17.4 PD in the medial rectus muscle resection group and 18.1 PD in the lateral rectus muscle re-recession group. Successful outcomes were achieved in 9 of 14 patients (64%) treated with medial rectus muscle resection and 19 of 26 patients (73%) treated with lateral rectus muscle re-recession. There was no statistically significant difference between these outcomes. Mean follow-up was 4.5 years in the medial rectus muscle resection group and 2.9 years in the lateral rectus muscle re-recession group. Surgery on a single muscle can be used to treat moderate-angle recurrent or persistent exotropia. Unilateral re-recession of the lateral rectus muscle and medial rectus muscle resection have equivalent success rates.

Surgical Outcome of Sensory Exotropia with Distant-Near Disparity

Purpose: To assess clinical features of sensory exotropia with distant-near disparity, surgical outcome, and compare according to amount of medical rectus resection. Methods: Authors retrospectively reviewed medical records of patients of sensory exotropia with follow-up over 6 months. We defined patients with over 10 prism diopter (PD) disparity as distant-near disparity sensory exotropia (DND-XT) and without disparity as basic sensory exotropia (B-XT). First, we analyzed and compared data of visual acuity, cause and age of visual loss, amount of deviation. Second, Surgical failure was analyzed with dividing DND-XT into conventional surgery group as Parks’ formula and reduced medial rectus resection group in accordance with disparity. Surgical success was defined as less than 10 PD deviation in distant, near fixation. Results: B-XT consisted of 58 patients (40 males) and DND-XT of 33 patient (13 males). There was no significant difference between 2 groups in onset and cause of visual loss, deviation at distant fixation. But, log MAR visual acuity of worse eye was better in DND-XT than B-XT (1.74 ± 0.78, vs. 2.10 ± 0.74, p = 0.039). Average deviation in distant fixation in DND-XT was 46.55 ± 16.59 PD in distant and 14.93 ± 8.91 PD in near fixation. All patients underwent surgery of medial rectus resection and lateral rectus recession and average deviation was 6.83 ± 7.71 PD at distant fixation, 3.02 ± 0.69 PD at near fixation at last follow-up. Among 33 patients, 16 patients underwent conventional amount of surgery and 17 patients with reduced medial rectus resection. In patient with conventional surgery, 9 patients were surgical failure (8 patients of over-, 1 patient of under-correction) but in patient with reduced amount of resection, only 1 patient was under-correction. Conclusions: As a result of medial rectus resection and lateral rectus recession in DND-XT, more surgical failures due to over-correction were observed with conventional resection and higher surgical success was attained in consideration of disparity. J Korean Ophthalmol Soc 2015;56(10):1599-1603

Superior Oblique Anterior Transposition with Horizontal Recti Recession-Resection for Total Third-Nerve Palsy.

Aims. To report the results of lateral rectus muscle recession, medial rectus muscle resection, and superior oblique muscle transposition in the restoration and maintenance of ocular alignment in primary position for patients with total third-nerve palsy. Methods. The medical records of patients who underwent surgery between March 2007 and September 2011 for total third-nerve palsy were reviewed. All patients underwent a preoperative assessment, including a detailed ophthalmologic examination. Results. A total of 6 patients (age range, 14–45 years) were included. The median preoperative horizontal deviation was 67.5 Prism Diopter (PD) (interquartile range [IQR] 57.5–70) and vertical deviation was 13.5 PD (IQR 10–20). The median postoperative horizontal residual exodeviation was 8.0 PD (IQR 1–16), and the vertical deviation was 0 PD (IQR 0–4). The median correction of hypotropia following superior oblique transposition was 13.5 ± 2.9 PD (range, 10–16). All cases were vertically aligned within 5 PD. Four of the six cases were aligned within 10 PD of the horizontal deviation. Adduction and head posture were improved in all patients. All patients gained new area of binocular single vision in the primary position after the operation. Conclusion. Lateral rectus recession, medial rectus resection, and superior oblique transposition may be used to achieve satisfactory cosmetic and functional results in total third-nerve palsy.

Dose-Effect Relationship of Unilateral Medial Rectus Resection for Recurrent Exotropia

Purpose: To investigate the dose-effect relationship of unilateral medial rectus resection for recurrent exotropia after bilateral lateral rectus recession. Methods: This study comprised 39 patients who underwent unilateral medial rectus resection for recurrent exotropia under 25 PD and bilateral rectus recession for prior surgery of exotropia. The medial rectus was resected from 5.0 to 7.0 mm according to angle deviation at a distance. The postoperative deviated angle was checked at one week, 3 months and 6 months postoperatively to investigate the amount of corrected deviation per resected muscle. Results: The average preoperative deviation was 21.33 ± 2.96 PD. We resected mean 6.26 ± 0.57 mm of the medial rectus muscle. The postoperative deviated angle was 0.82 ± 3.47, 1.87 ± 3.10 and 5.40 ± 4.79 PD at 1 week, 3 months and 6 months after surgery, respectively. The corrected deviated angle per millimeter (mm) was 3.29 ± 0.68, 3.17 ± 0.58 and 2.75 ± 0.89 PD at 1 week, 3 months and 6 months after surgery. There were no significant differences among the changes of postoperative deviation per millimeter according to the amount of medial rectus (MR) resection (p-value = 0.423, 0.382) The success rate was 89.75%, 92.31% and 87.18% at 1 week, 3 months and 6 months after surgery, respectively. The expected corrected angle according to the amount of resection remained constant and was 3.04-3.22 PD/mm at 3 months after surgery and 2.79-2.82 PD/mm at 6 months after surgery. Conclusions: The dose-effect per millimeter was decreased as time passed. There was no statistical difference among the corrected deviation angles per millimeter according to the amount of MR resection. We expect that the calculated dose-effect relationship may be a useful guideline for unilateral medial rectus resection for recurrent exotropia. J Korean Ophthalmol Soc 2015;56(3):420-426

Surgical outcome of medial rectus resection in recurrent exotropia: a novel surgical formula.

Purpose. To evaluate the surgical outcomes of unilateral or bilateral medial rectus (MR) muscle resection for recurrent exotropia after bilateral lateral rectus (BLR) muscle recession based on a novel surgical formula. Methods. Forty-one consecutive patients with unilateral or bilateral MR muscle resection for recurrent exotropia after BLR muscle recession were included in this retrospective study. All surgeries were performed according to the formula: 1.0 mm MR muscle resection for every 5 prism dioptres (PD) of exotropia, with an addition of 0.5 mm to each MR muscle operated on. Results. The mean recurrent exotropia distant deviation was 28 PD ± 11.2 (range 14 to 55 PD). Overall at postoperative 1 month, 36 (88%) achieved successful outcomes, 4 (10%) had undercorrection, and 1 (2%) had overcorrection. At postoperative 6 months, 29 (71%) achieved successful outcomes, 12 (29%) had undercorrection, and none had overcorrection. Subgroup analysis showed no statistically significant difference in success rates between unilateral and bilateral MR groups. Conclusion. Unilateral or bilateral MR muscle resection using our surgical formula is a safe and effective method for calculating the amount of MR resection in moderate to large angle recurrent exotropia, with a low overcorrection rate.

Conjunctival Pyogenic Granuloma after Strabismus Surgery

A 48-year-old man presented with exotropia of his left eye. The alternative prism cover test demonstrated there was 60 prism diopter exotropia. A 9 mm lateral rectus muscle recession and a 7 mm medial rectus muscle resection were performed in his left eye. Approximately one month later, a polypoid, red, smooth-surfaced mass arose from the area overlying the original insertion of lateral rectus muscle (Figure 1A). We diagnosed this mass as pyogenic granuloma. One month after administration with topical corticosteroid drops, this mass was completely resolved (Figure 1B). There was no recurrence during the 2 years after surgery.

Comparison of lateral rectus muscle re-recession versus medial rectus muscle resection for treatment of moderate angle recurrent exotropia

Recurrent strabismus may develop following surgical treatment for exotropia. We compared the outcomes of unilateral lateral rectus muscle re-recession (LRReRc) and medial rectus muscle resection (MRRs) for treatment of this condition.

How to understand the excessive lateral rectus muscle recession

Surgical treatments of intermittent exotropia include symmetric bilateral lateral rectus recession, symmetric bilateral medial rectus resection, asymmetric monocular lateral rectus recession and/or medial rectus resection, in which lateral rectus recession is the most common method. The maximum amount of lateral rectus recession, however, is still controversial. Bilateral lateral rectus recession 7-8 mm for 35(Δ)-40(Δ) exotropia and unilateral lateral rectus recession and medial rectus resection for exotropia larger than 40(Δ) are suggested by most doctor usually. But some other doctors advocated augmented bilateral lateral rectus recession (9-14 mm ) for exotropia larger than 50(Δ) or augmented unilateral lateral rectus recession for moderate angle exotropia (30(Δ)-35(Δ)), which brought confusion in practical clinical work. In this paper, we'll focus on the amount of lateral rectus recession, and discuss several common issues related to augmented lateral rectus recession, in order to provide references for the majority of clinicians.

Comparison of different surgery procedures for convergence insufficiency-type intermittent exotropia in children

AimsTo compare prospectively the surgical outcomes of different surgery procedures for convergence insufficiency (CI)-type intermittent exotropia (IXT) in children.MethodsForty-five children with CI-type IXT were included in this prospective surgical study...