Long-term surgical outcomes and factors for recurrence after unilateral lateral rectus muscle recession

Lyu, In Jeong; Park, Kyung-Ah; Oh, Sei Yeul

doi:10.1136/bjophthalmol-2015-307970

Cited by 10 publications

(13 citation statements)

References 11 publications

(17 reference statements)

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“…ULR for small-angle exotropia appear frequently in literature with various surgical dosages and surgical outcomes. Previous noncomparative studies concluded that ULR is effective, with success rates ranging from 73% to 100%, 9,10,12,13,15,17,[19][20][21][22][23] whereas one study showed poor surgical outcomes with a success rate of 36%, a 63% recurrence rate and 1% overcorrection rate. 33 Several authors reported that ULR surgical results were acceptable and comparable to bilateral lateral rectus recession (BLR) or URR.…”

Section: Discussionmentioning

confidence: 96%

“…[32][33][34] Notably, most previous publications had retrospective designs. [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] Owing to inconsistent surgical results, lack of standardized surgical dosage, possible risk of postoperative incomitance, and the limited number of prospective studies, in this study, we proposed a fixed amount of recession, addressed surgical outcomes, and evaluated postoperative incomitance prospectively in adults with 15-25 PD of horizontal deviation who underwent unilateral lateral rectus recession (ULR) for XT or unilateral medial rectus recession (UMR) for ET. This study specifically investigated patients with 15-25 PD deviation and did not cover those with the larger angle of deviation.…”

Section: Introductionmentioning

confidence: 99%

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A Prospective Study of One-Muscle Surgery in 15–25 Prism Diopters Horizontal Comitant Strabismus in Adults

Lekskul¹,

Wuthisiri²,

Jarupanich³

2021

OPTH

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Purpose: To prospectively evaluate the results of one-muscle surgery in 15-25 prism diopters (PD) horizontal comitant strabismus in adults. Patients and Methods: 15-25 PD horizontal strabismus patients, comprising 25 exotropic (XT) patients and 11 esotropic (ET) patients, who underwent one-muscle recession by a single surgeon with a fixed surgical dosage were included in the study with a minimum follow-up of 3 months. The main outcome was a surgical success, which is defined as a residual deviation of <8 PD at the last examination. Other parameters include postoperative lateral incomitance and patient satisfaction. Postoperative lateral incomitance indicated a difference in deviation of >5 PD between the primary position and lateral gaze, or duction limitation at any visit. Patient satisfaction regarding cosmetic and functional outcomes was assessed by using a 5-point Likert scale. Results: Successful alignment was obtained in 19 (76%) and 9 (81.81%) XT and ET patients (p = 1.00), with a median and interquartile range (IQR) of follow-up time of 3, 3-3 months and 3, 3-7 months, respectively. Postoperative lateral incomitance was observed in 8 (32%) XT patients and in 1 (9.09%) ET patient (p = 0.22). One XT patient and one ET patient who developed incomitance reported diplopia, which disappeared 3 months after surgery. One XT patient reported diplopia while gazing towards the operated eye whilst one ET patient reported diplopia occasionally which was unrelated to gaze direction. Patient satisfaction was based on Likert scale scores with 4.12 ± 0.97 in XT patients and 4.73 ± 0.65 in ET patients (p = 0.07). Conclusion:One-muscle recession with a fixed surgical dosage was effective for treating small angle horizontal strabismus with a high rate of surgical success and patient satisfaction. Although postoperative lateral incomitance occurred, only a few patients developed symptomatic diplopia, which completely resolved 3 months after surgery.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

A Prospective Study of One-Muscle Surgery in 15–25 Prism Diopters Horizontal Comitant Strabismus in Adults

Lekskul¹,

Wuthisiri²,

Jarupanich³

2021

OPTH

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“…We performed a larger amount of LR recession compared to the surgical recommendation by Wilson et al [6] Notably, this surgical table was similar to the surgical dosages used for unilateral rectus muscle recession in children with basic-type intermittent XT under 25 PD of angle of exodeviation. [13] The difference was that we added posterior fixation sutures in patients with DHD and monocular exodeviation of �30 PD. On the basis of our long-term surgical results, we suggest the augmented surgical table for patients with DHD.…”

Section: Plos Onementioning

confidence: 99%

Long-term results of augmented unilateral lateral rectus muscle recession for dissociated horizontal deviation

Lyu

Han

2020

PLoS ONE

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We report the long-term surgical results of augmented lateral rectus muscle (LR) recession for dissociated horizontal deviation (DHD) without concomitant exotropia (XT) or esotropia (ET). This retrospective review included patients with DHD without XT or ET who underwent augmented LR recession and were followed-up for �12 months. Each patient's medical records were evaluated to identify their demographics, preoperative angle of deviation, surgical procedure, success rate, and reoperation rate. A total of 11 patients with DHD were included (median patient age at surgery, 6 years; interquartile range [IQR], 5 to 10 years). Four patients (36.4%) had a history of infantile ET while three patients (27.3%) had a history of unilateral cataract surgery for congenital cataract. The median preoperative angle of DHD in the unilateral eye was 20 prism diopters (PD) (IQR, 15 to 25 PD). The median amount of LR recession was 8.0 mm (IQR, 7.5 to 8.0 mm). Three patients (27.3%) underwent simultaneous surgery for dissociated vertical deviation. At the final examination after a median follow-up period of 32 months (IQR, 24 to 58 months), 10 patients (91%) showed successful alignment. The long-term successful alignment rate after augmented LR recession for DHD was good; thus, application of this technique is appropriate in patients with DHD.

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“…Small angle X(T) has been successfully managed by unilateral lateral rectus recession (ULRc), BLRc and R&R,36–38 but preoperative deviation of 20–25 PD X(T) had worse outcomes than <20 PD X(T) 37. However, long-term results have been contradictory for ULRc with few studies showing good outcomes,36 38 39 while other showing poor outcomes compared with R&R 40.…”

Section: Surgical Modalitiesmentioning

confidence: 99%

“…Few studies have suggested that preoperative deviation less than 40 PD does not affect the final surgical outcomes,58 63 while greater preoperative deviation especially if >40 PD is associated with poor outcomes 66 76 77 90. In authors’ opinion, preoperative exodeviations lying within the grey zone which pose the dilemma of whether to add an extra muscle like 20-25 PD (1 or 2 muscles), 45–55 PD (2 or 3 muscles) and 60-90 PD (3 or 4 muscles) have unpredictable outcomes, with most unpredictable outcomes in the first group of 20–25 PD 37. The surgical dosage for X(T) has been discussed in table 2.…”

Section: Factors Affecting Surgical Outcomesmentioning

confidence: 99%

Surgical management of intermittent exotropia: do we have an answer for all?

Chougule

Kekunnaya

2019

BMJ Open Ophth

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Intermittent exotropia (X(T)) is one of the most common form of strabismus with surgery being the mainstay of treatment. The main goal of surgery is to preserve binocular vision and stereopsis and to prevent its further loss. The decision to operate is mainly based on four aspects: increasing angle of exodeviation, deteriorating control of X(T), decrease in stereopsis for near or distance and quality of life. Bilateral lateral rectus muscle recession and unilateral lateral rectus recession with medial rectus resection, are the two most common surgical procedures performed and have been studied extensively in basic, divergence excess and convergence insufficiency types of X(T). However, there is no consensus over the relative efficacy of the two procedures in terms of postoperative alignment, residual or recurrent exotropia and consecutive esotropia with widely variable results, which can be attributed to poor understanding of the natural course of the disease. Multiple demographic, clinical and anatomic features that may influence the surgical outcomes have been studied to explain this variability. Moreover, most of the evidence regarding surgical outcomes of X(T) is from retrospective studies and the ongoing randomised prospective trials can shed light on long-term efficacy of these procedures. The goal of this review is to give a comprehensive overview of the outcomes of various surgical techniques in the management of different types of X(T), the preoperative and postoperative factors that may affect the surgical outcomes and to discuss the dilemmas faced by the treating surgeons including the effective management of overcorrection and undercorrection.

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Long-term surgical outcomes and factors for recurrence after unilateral lateral rectus muscle recession

Abstract: The overall long-term successful alignment rate of ULR for 15-24 PD of IXT was good. However, patients with 20-24 PD of IXT showed worse prognosis compared with 15-19 PD of IXT.

Cited by 10 publications

References 11 publications

A Prospective Study of One-Muscle Surgery in 15–25 Prism Diopters Horizontal Comitant Strabismus in Adults

A Prospective Study of One-Muscle Surgery in 15–25 Prism Diopters Horizontal Comitant Strabismus in Adults

Long-term results of augmented unilateral lateral rectus muscle recession for dissociated horizontal deviation

Surgical management of intermittent exotropia: do we have an answer for all?

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