Early Results of Slanted Recession of the Lateral Rectus Muscle for Intermittent Exotropia with Convergence Insufficiency

Chun, Bo Young; Kang, Kyung Hee

doi:10.1155/2015/380467

Cited by 14 publications

(30 citation statements)

References 17 publications

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“…Utilizing a similar surgical technique for bilateral LR recession, Chun and Kang achieved a success rate of 83.9% in children. [6] Success in both studies was defined with the same criteria as this study: A post-operative residual deviation at near or distance of ≤8 PD and a NDD ≤8 PD.…”

Section: Discussionmentioning

confidence: 99%

“…[2,3] For those patients who fail non-surgical options, existing surgical techniques are often unreliable as no single operation is proven to reliably collapse near-distance disparity while also achieving satisfactory alignment at both distance and near. Various surgical treatments for CI-type exotropia (CI-XT) have been evaluated, including bilateral lateral rectus (LR) recession with and without slanting, [4][5][6][7] bilateral medial rectus (MR) resection with and without slanting, [8][9][10] unilateral MR resection, [11] unilateral LR recession with MR resection (R&R), [12,13] and variations of the above with adjustable sutures. In a direct comparison of reports of bilateral R&R with or without slanting, unilateral MR resection with or without slanting and unilateral R&R, it was found that unilateral R&R with MR resection based on the near deviation, and LR recession based on the distance deviation achieved the best alignment.…”

Section: Introductionmentioning

confidence: 99%

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Treatment of convergence insufficiency exotropia in adults using a selective muscle fiber surgery algorithm

Fry¹,

Pineles²,

Velez³

2018

cleverjournal

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Introduction: Treatment of adults with convergence insufficiency-type (CI-XT) exotropia is challenging as surgery frequently results in distance and lateral gaze esotropia. Recent evidence demonstrates differential compartmental function of extraocular muscle fiber groups. Selective surgery of muscle fiber groups may diminish near-distance disparities (NDD) while maintaining alignment at distance. Methods: Seven adults with a NDD ≥8 prism diopter (PD) were included in this study. Patients with a NDD <15 PD and a distance deviation of <10 PD were treated with lateral rectus (LR) inferior marginal tenotomy, those with NDD >15 PD and distance deviation of >10 PD were treated with LR slanted recessions, and those with limitation in adduction with negative forced duction testing were treated with medial rectus (MR) inferior fiber plication. Success was defined as <8 PD of XT at distance and near without overcorrection and a NDD ≤8 PD. Results: Postoperatively, the mean distance deviation was reduced from 7.71 ± 6.87 PD to an overcorrection of 1.43 ± 3.78 PD, and the near deviation from 20.29 ± 9.57 PD to 0.86 ± 1.57 PD. The NDD was reduced from 12.57 ± 3.15 to 2.29 ± 3.73 PD. Six of the 7 (85.7%) patients met criteria for success. One subject was overcorrected at distance and two were slightly undercorrected at near but without diplopia. Discussion: CI exotropia remains a surgical challenge. Treatment may be optimized when using an individualized approach favoring selective LR and MR procedures when possible. Conclusions: Preliminary data reveal that selective techniques may eliminate diplopia while collapsing NDD in patients with CI-XT. A focused algorithm will help surgeons select the procedure most likely to benefit each individual patient.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Treatment of convergence insufficiency exotropia in adults using a selective muscle fiber surgery algorithm

Fry¹,

Pineles²,

Velez³

2018

cleverjournal

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“…Non-surgical treatments such as orthoptic treatment, base-in prism reading glasses, vision therapy and psychotherapy could be used to alleviated symptoms in some patients. [2] Surgical management is required for patients that do not respond to these measures or for patients whose deviations are too large or poorly controlled [3]. The various surgical procedures for CI-IXT include unilateral or bilateral medial rectus (MR) resection(s), bilateral lateral rectus (LR) recessions, unilateral LR recession combined with MR resection [4][5][6][7], MR resection with adjustable sutures [3], slanted bilateral MR resections [8][9][10], improved unilateral LR recession combined with MR resection [11][12][13], and slanted bilateral lateral rectus recession (SBLR-rec) [1-2, 14,15].…”

Section: Introductionmentioning

confidence: 99%

“…and SBLR-rec (the upper pole of the LR was recessed according to the distance deviation and the lower pole was recessed according to the near deviation)[1][2]. Nemet first and then Biedner performed the slanted bilateral MR resections (SBMR-Res) in 3 patients of CI-IXT respectively, and both reported fairly good outcomes [8][9].…”

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confidence: 99%

Slanted bilateral lateral rectus recession for convergence insufficiency-type intermittent exotropia: a retrospective study

Ren

Wang

2020

Preprint

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Background The present study sought to investigate the efficiency and safety of SBLR-rec for the treatment of CI-IXT.Methods This retrospective case series study included 34 patients who underwent SBLR-rec for CI-IXT in Shandong Provincial Hospital affiliated to Shandong University between September 2013 and October 2015 with a minimum follow-up of 6 months. A successful surgical alignment was defined as +5 to -10 prism diopters (PD) of orthophoria in the primary position while viewing distant or near targets and a difference between the distance and near deviation angles of ≤8PD.Results The mean age of the patients at surgery was 7.09±3.80 years (range, 3 to 18 years). The mean distance deviations were -26.09±6.5 PD (range, -15 to -35 PD) and the mean near deviations, -37.21±6.3 PD (range, -25 to -45 PD) preoperatively. The mean recession amount of upper pole of the lateral rectus was 5.97 mm (range, 4.0 to 7.5mm) and that of lower pole of the lateral rectus, 7.49 mm (range, 6.0 to 8.5mm). At a mean follow-up of 15.0 months (range, 6 to 37 months), the surgical success rate was 70.6% (24/34), the under-correction rate was 17.6% (6/34), and the overcorrection rate was 11.8% (4/34). The mean difference between the distance and near deviation angles was significantly reduced from 11.12±2.06 PD (range, 10 to 15 PD) preoperatively to 2.47±3.04 PD (range, 0 to 10 PD) postoperatively (P<0.001). Each millimeter of difference between the upper and lower poles of the lateral rectus recession was associated with an improvement of 5.65 PD in the near-distance difference of deviation. At the final follow up, a distance-near difference of deviation of ≤8PD was found in 32 (94.1%) patients. none of the patients developed A-V pattern, torsional diplopia, or restricted abduction of the eyes.Conclusions SBLR-rec for CI-IXT may successfully reduce the distance and near exodeviations and the distance-near deviation difference, thus was proved to be an effective and safe procedure for the treatment of CI-IXT.

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“…We congratulate Chun and Kang for their successful results which they obtained in children with exotropia with convergence weakness [1]. This issue is one of the controversial topics, in which there are still diverse opinions in its treatment, in which a full consensus cannot be built in surgical treatment, and in which various success rates within the range of 18–67% are reported [2–4].…”

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confidence: 99%

Comment on “Early Results of Slanted Recession of the Lateral Rectus Muscle for Intermittent Exotropia with Convergence Insufficiency”

Ceylan

Ayyıldız

Gökçe

et al. 2016

Journal of Ophthalmology

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Early Results of Slanted Recession of the Lateral Rectus Muscle for Intermittent Exotropia with Convergence Insufficiency

Cited by 14 publications

References 17 publications

Treatment of convergence insufficiency exotropia in adults using a selective muscle fiber surgery algorithm

Treatment of convergence insufficiency exotropia in adults using a selective muscle fiber surgery algorithm

Slanted bilateral lateral rectus recession for convergence insufficiency-type intermittent exotropia: a retrospective study

Comment on “Early Results of Slanted Recession of the Lateral Rectus Muscle for Intermittent Exotropia with Convergence Insufficiency”

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