Divergence insufficiency

Thomas, Arthur H.

doi:10.1067/mpa.2000.111783

Cited by 30 publications

(22 citation statements)

References 10 publications

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“…Indeed, Thomas reported that the two divergence insufficiency patients he treated with unilateral medial rectus muscle recession developed incomitance, with better abduction on the side of the operated eye. 19 These results are consistent with remaining mechanical restriction in the unoperated medial rectus muscle.…”

Section: Discussionsupporting

confidence: 90%

“…Thomas successfully eliminated diplopia in seven patients with divergence insufficiency by weakening one or both medial rectus muscles. 19 The patients in these studies differ from our patients in that the average age was less than 25 years and there was no observed limitation of abduction. Information regarding duration of symptoms and postoperative measurements of possible latent strabismus were not specified in these studies.…”

Section: Discussionmentioning

confidence: 59%

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Bilateral medial rectus muscle recession for divergence insufficiency pattern esotropia

Bothun

Archer

2005

Journal of American Association for Pediatric Ophthalmology and

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 59%

Bilateral medial rectus muscle recession for divergence insufficiency pattern esotropia

Bothun

Archer

2005

Journal of American Association for Pediatric Ophthalmology and

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“…5,11 Though not specifically reported for DPE associated with connective tissue degeneration in elderly individuals, MR recession has been reported to be as effective as LR resection for correcting distance ET. 7,15,26,27 In this report, adjustable LR resection with average (SD) surgical dose of 4.5 (1.2) mm was effective for correcting DPE and did not cause consecutive exotropia. Adjustable MR recession with an average (SD) dose of 3.7 (0.7) mm was found to be equally effective to LR resection.…”

mentioning

confidence: 61%

Medial rectus recession is as effective as lateral rectus resection in divergence paralysis esotropia

Zia¹,

Demer²

2012

Journal of American Association for Pediatric Ophthalmology and

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Objective-To propose medial rectus (MR) recession to be equally as effective as lateral rectus (LR) resection, which has heretofore been the preferred treatment for divergence paralysis esotropia (DPE).Methods-We examined a 17-year surgical experience comparing LR resection with MR recession in adults with DPE, defined as symptomatic distance esotropia (ET) at least double the asymptomatic ET of 10 or less prism diopters (Δ) at near.Results-Twenty-four patients with DPE underwent surgery. Six patients underwent bilateral LR resection and 2 underwent unilateral LR resection (group L), while 13 underwent bilateral MR recession and 3 underwent unilateral MR recession, with the target angle double the distance ET (group M). One of 8 patients in group L and 15 of 16 patients in group M underwent intraoperative adjustable surgery under topical anesthesia. Mean (SD) preoperative central gaze ET measured 15.0 (7.7) Δ at distance and 4.1 (3.4) Δ at near in group L, but 10.4 (6.8) Δ at distance and 0.6 (1.7) Δ at near in group M (P=.15; distance, 0.003, near). Postoperatively, no patient in either group had symptomatic diplopia or convergence insufficiency in follow-up from 8.5 to 40 months. Twice the usual surgical dose of MR recession per prism diopter was required to achieve correction of the distance deviation in DPE as compared with that recommended for ET generally and also for LR resection in the same condition.Conclusions-Recession of the MR provides binocular single vision in DPE without convergence insufficiency at near, and it is convenient for intraoperative adjustment under topical anesthesia.Divergence paralysis esotropia (DPE)-variably termed divergence insufficiency, divergence insufficiency esotropia, and divergence paresis esotropia-is characterized by comitant esotropia (ET) at distance fixation associated with symptomatic diplopia, fusion at near fixation, and normal saccadic velocities in adduction and abduction. As the name implies, early thinking about DPE was dominated by the presumed pathophysiological concept of a brain lesion involving a putative divergence center. 1,2 Indeed, isolated clinical reports have associated DPE with neurologic conditions such as brain tumors, multiple sclerosis, trauma, subdural hematoma, and tertiary syphilis. [2][3][4][5] Even postulated as a cause of DPE was increased medial rectus (MR) muscle tonicity as a compensatory mechanism for © 2012 American Medical Association Correspondence: Joseph L. Demer, MD, PhD, Jules Stein Eye Institute, University of California, Los Angeles, 100 Stein Plaza, Los Angeles, CA 90095-7002 (jld@ucla.edu). Author Contributions: Both authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. 8 Therefore, it has most recently been proposed that DPE is more typically a mechanical rather than a neurogenic disorder. Although based on the modern proposal for etiology, the term DPE has become a misnomer; it is used here as a convenience for reference...

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“…It is well recognized that this does not occur, but even more surprising are the few reports suggesting that these procedures even reduce distance-near incomitance in contrary cases (medial rectus muscle recessions for esotropia greater at distance 24,25 and lateral rectus muscle recessions for exotropia greater at near). 5,6 This study does not support the concept that lateral or medial rectus muscle surgery preferentially influence distance or near alignment, respectively.…”

Section: Volume 13 Number 1 / February 2009mentioning

confidence: 85%

The effect of medial versus lateral rectus muscle surgery on distance-near incomitance

Archer

2009

Journal of American Association for Pediatric Ophthalmology and

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Divergence insufficiency

Cited by 30 publications

References 10 publications

Bilateral medial rectus muscle recession for divergence insufficiency pattern esotropia

Bilateral medial rectus muscle recession for divergence insufficiency pattern esotropia

Medial rectus recession is as effective as lateral rectus resection in divergence paralysis esotropia

The effect of medial versus lateral rectus muscle surgery on distance-near incomitance

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