J Korean Ophthalmol Soc.  2020 Mar;61(3):281-287. 10.3341/jkos.2020.61.3.281.

Changes in the Effects of Bilateral Lateral Rectus Muscle Recession According to Preoperative Angle Deviation

Affiliations
  • 1Department of Ophthalmology, Gachon University Gil Medical Center, Incheon, Korea. hjpaik@gilhospital.com

Abstract

PURPOSE
To investigate how the effect of bilateral rectus muscle recession changed by analyzing the effect/dose ratio of surgery according to the preoperative angle deviation.
METHODS
We retrospectively studied the medical records of patients from January 2007 to March 2014 who underwent bilateral lateral rectus muscle recession and who visited our hospital for at least 2 years after surgery. We classified the patients into two groups: the preoperative large angle deviation group (35 prism diopters [PD] or more) and the small angle deviation group (20 PD or less). We observed exodrift patterns by measuring distant and near angle deviation according to the preoperative and postoperative times. The effect/dose ratio of recession was calculated at each visit. Surgical success was defined as an alignment between 10 PD of exodeviation and 5 PD of esodeviation, both at distance and at near.
RESULTS
Among 165 patients, 84 patients were in the large angle deviation group and 81 patients were in the small angle deviation group. Preoperative angle deviation of the large angle deviation group was 39.34 ± 5.13 PD (range: 35-55 PD) and the small angle deviation group was 19.49 ± 1.62 PD (range: 18-20 PD) (p < 0.001). At postoperative 1 day, the alignments of eyes of the two groups were −8.32 ± 9.31 PD and −13.11 ± 6.94 PD; p < 0.001, respectively. At the date of the final follow-up, the alignments of eyes of the two groups were 4.63 ± 8.94 PD and 1.22 ± 8.01 PD; p = 0.011, respectively, and the effect/dose ratios were 2.25 ± 0.62 PD/mm and 1.94 ± 0.78 PD/mm, respectively, which meant that the effect of correction for the large angle deviation group was larger than that of the small angle deviation group (p = 0.005). Both groups showed postoperative exodrift patterns and similar success rates (75.0% and 80.2%, respectively), which showed no significant difference (p = 0.268).
CONCLUSIONS
The small angle deviation group showed a larger effect of correction and high exodrift pattern at the postoperative initial time and the large angle deviation group showed a smaller effect of correction and low exodrift pattern at the postoperative initial time. The preoperative angles of deviation and the operative success rates were not related.

Keyword

Bilateral lateral rectus muscle recession; Intermittent exotropia

MeSH Terms

Esotropia
Exotropia
Follow-Up Studies
Humans
Medical Records
Retrospective Studies

Figure

  • Figure 1. Changes in angle of deviation at distance during post-operative follow-up. Mean angle of deviation showed significant difference at all dates. * Mann-Whitney U-test (p < 0.05).

  • Figure 2. Change in amount of corrected prism diopters (PD) per lateral recession (mm) in large angle and small angle groups (dose-effect relationship). Mean PD/mm showed significant difference at postoperative 1 day, 1 year, 2 years and last follow-up. * Mann-Whitney U-test (p < 0.05).

  • Figure 3. Diagram of lateral rectus (LR) muscle and other structures. (A) Pulley of LR is located 2–4 mm posterior to the equator originally. (B) After large amount of recession on LR, pulley is translocated largely to the lateral side and causes strong passive elastic tension, which has the exodeviation force. (C) After small amount of recession on LR, pulley is translocated smally to the lateral side and causes weak passive elastic tension initially. (D) At the final state after small recession of LR, as the pulley is deviated later-ally, passive elastic tension becomes strong. LR = lateral rectus muscle.


Reference

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