Dose Effect and Stability of Postoperative Cyclodeviation After Adjustable Harada-Ito Surgery

Liebermann, Laura; Hatt, Sarah R.; Bata, Bashar M.; Holmes, Jonathan M.

doi:10.1016/j.ajo.2018.08.036

Cited by 7 publications

(3 citation statements)

References 10 publications

(13 reference statements)

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“…Surgery usually warrants some modifications or adjustments to the individual anatomy or pathology to achieve a satisfactory result. The most common approach is to adopt an adjustable suture technique and adjust the correction postoperatively within a day based on a subjective measure, such as a DMR test (28,29). Intraoperative one-stage adjustment under topical anesthesia had been proposed by Xie et al achieved positive results (31); however, this approach is challenging in children or uncooperative adult patients.…”

Section: Discussionmentioning

confidence: 99%

“…However, the resulting cyclo-alleviating effect of the same muscle procedure can vary greatly, and the outcome is often unpredictable with different etiologies and individual anatomical conformations (26,27). Surgical techniques allowing postoperative (28)(29)(30) or intraoperative adjustments under local anesthesia (31) have been proposed. However, these modified techniques can be burdensome for young children and uncooperative adult patients, rendering them occasionally unsuitable.…”

Section: Introductionmentioning

confidence: 99%

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A simple marking system for accurate intraoperative monitoring and adjustment of cyclotorsion strabismus surgery

et al. 2023

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Ocular cyclotorsion is treatable only with surgery. The surgical procedure must be tailored individually to the specific etiologies causing the horizontal and vertical strabismus and its torsional components. An adjustable surgical approach is often used for postoperative or intraoperative adjustments. However, the methods currently used have some limitations. In this study, we propose a simple intraoperative marking system for all cyclotorsion correction surgery. The proposed marking system used three sets of surface markers: external horizontal markings, ocular horizontal markings, and surgical torsion markings, drawn in sequence. We retrospectively analyzed the surgical results using this novel marking system in this single-center, single-surgeon study. Fifteen patients with cyclotorsion who underwent treatment using the proposed marking system as an intraoperative aid between August 2019 and August 2021 were included. The medical charts were thoroughly reviewed, and the pre-and postoperative subjective and objective cyclotorsion were analyzed. Among the study subjects (10 males, 5 females; age range: 6–89 years), 13 had excyclotorsion and 2 incyclotorsion. Preoperative mean net subjective cyclotorsion measured by the double Maddox rod (DMR) test was 6.0° (standard deviation: 10.8°) and mean net disc-to-fovea angle (DFA) was 20.23° (13.21°). The postoperative net DMR and DFA were 0.2° (2.1°) and 14.09° (5.97°), respectively. The mean absolute net DMR and DFA being treated were 9.8° (4.8°) and 9.76° (4.61°). Overall, the proposed intraoperative marking system is a simple and quantitative method to assess, monitor, and adjust the torsional aspect for all strabismus surgeries.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A simple marking system for accurate intraoperative monitoring and adjustment of cyclotorsion strabismus surgery

et al. 2023

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“…To increase the success rate of the surgery, an adjustable technique is applied, and the results of the adjustable surgery were favorable. 6,7 However, an adjustable surgery is associated with several complications such as vagal reactions during the adjustment procedure, increased postoperative inflammation, exposed sutures, and slipped adjustable suture knot. 8 Additionally, controversy about the success rate of adjustable suture surgery exists.…”

Section: Introductionmentioning

confidence: 99%

Surgical Outcomes of Nonadjustable Modified Harada-Ito Surgery

Yoon

Kim

2021

Korean J Ophthalmol

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This study aimed to investigate the surgical outcomes of nonadjustable Harada-Ito surgery under general anesthesia.Methods: Twenty-two patients who underwent nonadjustable modified Harada-Ito surgery under general anesthesia were reviewed retrospectively. Among them, 21 out of the 22 patients who were followed up for 6 months after surgery were included in this study. Subjective cyclotorsion (double Maddox rod test, DMRT) and objective cyclotorsions (fundus photography) were measured. Success of the surgery was defined as follows: success (the patients do not acknowledge diplopia at any direction), partial (the patients feel diplopia at a specific direction, but they do not feel discomfort in routine life), and fail (the patients feel diplopia in primary gaze, hence requiring a thorough investigation). Results:The mean age of the patients (18 men and 3 women) was 56.5 years (range, 40-77 years).Based on the alternate prism cover test, the patients had 4.2 ± 3.0 prism diopters of vertical deviation.The corrected amounts of cyclotorsion based on the DMRT and fundus photography were 14.8 ± 7.5° and 9.8 ± 7.9°, respectively, and were significantly different between the two methods (p=0.006). After the surgery, 20 out of the 21 patients (95.2%) completely recovered from diplopia in the primary gaze.However, among the 20 patients, seven complained of diplopia in the secondary gaze (down gaze, 4 patients; head tilt gaze, 3 patients). The success group had a smaller preoperative subjective excyclotorsion than the partial and fail groups (12.6 ± 2.5° and 21.0 ± 8.9°, respectively, p=.046). Conclusion:Nonadjustable modified Harada-Ito surgery under general anesthesia has favorable success rate, and preoperative subjective excyclotorsion can be a prognostic factor in patients with bilateral superior oblique palsy.

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Torsional incomitance after asymmetrically adjusted Harada-Ito procedures for the simultaneous correction of vertical and torsional deviations in bilateral trochlear nerve palsy

Jabroun

Marsh

Guyton

2021

Journal of American Association for Pediatric Ophthalmology and

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Dose Effect and Stability of Postoperative Cyclodeviation After Adjustable Harada-Ito Surgery

Abstract: Adjustable Harada-Ito advancement of the anterior fibers of the superior oblique tendon has a dose response of 1.3 degrees per millimeter, but its effect regresses over time. Based on our data, an immediate postoperative target incyclodeviation of 7 degrees is reasonable.

Cited by 7 publications

References 10 publications

A simple marking system for accurate intraoperative monitoring and adjustment of cyclotorsion strabismus surgery

A simple marking system for accurate intraoperative monitoring and adjustment of cyclotorsion strabismus surgery

Surgical Outcomes of Nonadjustable Modified Harada-Ito Surgery

Torsional incomitance after asymmetrically adjusted Harada-Ito procedures for the simultaneous correction of vertical and torsional deviations in bilateral trochlear nerve palsy

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