Surgical success and lateral incomitance following three-muscle surgery for large-angle horizontal strabismus.

Abstract

PURPOSE:

To evaluate motor alignment, motility, and sensorial outcomes of simultaneous three-muscle surgery for large-angle horizontal strabismus, with special attention to lateral incomitance and long-term success.

METHODS:

The medical records of consecutive patients with large-angle deviations (≥30Δ) who underwent simultaneous surgery on three horizontal muscles to correct esotropia or exotropia were reviewed retrospectively. Successful motor alignment was defined as residual deviation of ≤10Δ and consecutive deviation in primary position of ≤4Δ, with no induced lateral incomitance >5Δ between lateral gazes. Sensory success was defined as an improvement in stereopsis of ≥2 octaves. Surgical procedures included a combination of recessions and resections/plications depending on surgeon preference. The majority of cases were two-muscle recessions combined with one-muscle resection or plication.

RESULTS:

A total of 19 patients with exotropia and 9 patients with esotropia were included. In the esotropic group, the mean age at surgery was 48 ± 15 years and the mean preoperative deviation improved from 45.6Δ ± 11.9Δ to 1.5Δ ± 1.6Δ (P < 0.001); there was no undercorrection, recurrence or overcorrection. In the exotropic group, the mean age at surgery was 44 ± 25 years, and the mean preoperative deviation improved from 44.1Δ ± 8.7Δ to 5.8Δ ± 9.6Δ (P < 0.001), recurrence occurred in 2 (22%). Overall motor success at distance was 85%, with 1 (3.8%) unsuccessful patient due to induced incomitance. Sensory success was 44% for esotropia and 31% for exotropia. No patient lost stereopsis.

CONCLUSIONS:

Patients undergoing three-muscle surgery for horizontal strabismus had good motor outcomes with low incidence of induced lateral incomitance. Motor and sensorial outcomes for esotropia were very stable.

• Authors: Diana L Cifuentes, Stacy L Pineles, Joseph L Demer, Federico G Velez
• Journal: Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus (J AAPOS) Vol. 22 Issue 1 Pg. 17-21 (02 2018) ISSN: 1528-3933 [Electronic] United States
• PMID: 29199031 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2017 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Child
• Child, Preschool
• Depth Perception (physiology)
• Esotropia (physiopathology, surgery)
• Exotropia (physiopathology, surgery)
• Female
• Follow-Up Studies
• Humans
• Infant
• Male
• Middle Aged
• Oculomotor Muscles (physiology, surgery)
• Ophthalmologic Surgical Procedures (methods)
• Retrospective Studies
• Strabismus (physiopathology, surgery)
• Vision, Binocular (physiology)
• Young Adult