J Korean Ophthalmol Soc.  2012 Jul;53(7):1011-1015. 10.3341/jkos.2012.53.7.1011.

Surgical Outcome of Vertical Rectus Muscle Recession in Hypertropia

• Lee YH
• Rah SH

• KMID: 2215861
• DOI: http://doi.org/10.3341/jkos.2012.53.7.1011

Abstract

PURPOSE
To determine the extent of vertical rectus muscle correction in hypertropia showing good prognosis.
METHODS
A retrospective study was performed with a total of 16 patients who underwent superior or inferior rectus muscle recession surgery with a follow-up of more than 6 months. Vertical muscle recession of 1 mm per 2.5 to 3.0 prism diopters was performed according to the surgeon's discretion.
RESULTS
At 1 week after surgical correction, undercorrection, orthophoria, and overcorrection was observed in 4, 7 and 5 cases, respectively. At the final examination, ocular deviation was decreased in the undercorrected cases and maintained orthophoric except in 1 case where only a small amount of deviation recurred. However, in the cases of postoperative overcorrectionn, ocular deviation increased; 2 cases required surgical correction for consecutive hypertropia.
CONCLUSIONS
When performing vertical rectus muscle recession in primary hypertropia, the amount of correction for orthophoria or undercorrection should be determined.

Keyword

Hypertropia; Inferior rectus muscle recession; Superior rectus muscle recession

MeSH Terms

Follow-Up Studies
Humans
Muscles
Retrospective Studies
Strabismus

Figure

• 

  Figure 1 Change of postoperative angle of Deviation (mean) (Mean: prismdiopter). (A) Post op 1 wk undercorrected group. (B) Post op 1 wk orthotropia group. (C) Post op 1 wk overcorrected group. 0 = orthotropia. +: overcorrected angle of deviation. -: undercerrected angle of deviation.

• 

  Figure 2 Surgical result of Hypertropia correction.

Reference

1. Jampolsky A. Strabismus reoperation techniques. Trans Sect Ophthalmol Am Acad Ophthalmol Otolaryngol. 1975. 79:704–717.

2. Wisnicki HJ, Repka MX, Guyton DL. Reoperation rate in adjustable strabismus surgery. J Pediatr Ophthalmol Strabismus. 1988. 25:112–114.

3. Franklin SR, Hiatt RL. Adjustable sutures in strabismus surgery. Ann Ophthalmol. 1989. 21:285–289.

4. Kenneth WW, Laurie EC, Monte AD, et al. Color Atlas of Ophthalmic Surgery: Strabismus. 1991. 1st ed. Philadelphia: JB Lippincott;241–242.

5. Pratt-Johnson JA, Tilson G. Management of Strabismus and Amblyopia : A Practical Guide. 1994. 1st ed. New York: Thieme Medical Publishers;211.

6. Sprunger DT, Helveston EM. Progressive overcorrection after inferior rectus recession. J Pediatr Ophthalmol Strabismus. 1993. 30:145–148.

7. Lueder GT, Scott WE, Kutschke PJ, Keech RV. Long-term results of adjustable suture surgery for strabismus secondary to thyroid ophthalmopathy. Ophthalmology. 1992. 99:993–997.

8. Scotcher SM, O'Flynn EA, Morris RJ. Inferior rectus recession--an effective procedure? Br J Ophthalmol. 1997. 81:1031–1036.

9. Keech RV, Scott WE, Christensen LE. Adjustable suture strabismus surgery. J Pediatr Ophthalmol Strabismus. 1987. 24:97–102.

10. Lorenz B, Raab I, Boergen KP. Dissociated vertical deviation: What is the most effective surgical approach? J Pediatr Ophthalmol Strabismus. 1992. 29:21–29.

11. Cho IO, Lee SY. The surgical correction of vertical deviation after superior rectus muscle recession in patients with hypertropia. J Korean Ophthalmol Soc. 2005. 46:688–692.

12. Von Noorden GK. Binocular Vision & Ocular Motility : Theory and Management of Strabismus. 1990. 4th ed. St. Louis: CV Mosby Co;85–100.

13. Parks MM. Duane TD, editor. Vergences. Clinical Ophthalmology. 1983. v. 1:revised ed. Philadelphia: Harper and Row;chap. 7.

14. Pickwell D. Binocular Vision Anomalies, Investigation and Treatment. 1984. London; Boston: Butterworths;33–34.

15. Lee GY, Kim YY. Horizontal and vertical fusional amplitudes in normal eyes. J Korean Ophthalmol Soc. 1991. 32:1116–1122.

16. McNeer KW. Adjustable sutures of the vertical recti. J Pediatr Ophthalmol Strabismus. 1982. 19:259–264.

17. Weston B, Enzenauer RW, Kraft SP, Gayowsky GR. Stability of the postoperative alignment in adjustable-suture strabismus surgery. J Pediatr Ophthalmol Strabismus. 1991. 28:206–211.

18. Eustis HS, Leoni R. Early reoperation after vertical rectus muscle surgery. J AAPOS. 2001. 5:217–220.

19. Isenberg SJ, Abdarbashi P. Drift of ocular alignment following strabismus surgery. Part 2: using adjustable sutures. Br J Ophthalmol. 2009. 93:443–447.

20. Kim SJ, Kim SJ. Operations on vertical rectus muscles: Their influence on horizontal strabismus. J Korean Ophthalmol Soc. 2005. 46:462–465.