J Korean Ophthalmol Soc.  2022 Feb;63(2):211-215. 10.3341/jkos.2022.63.2.211.

Modified Harada-Ito Procedure with Intraoperative Adjustable Sutures Using a Mendez Ring for Excyclotorsion

• Shin YI
• Jung JH

• KMID: 2526512
• DOI: http://doi.org/10.3341/jkos.2022.63.2.211

Abstract

Purpose
We report a case of using a modified Harada-Ito procedure with intraoperative adjustment via a Mendez ring in a patient with bilateral superior oblique palsy, resulting in satisfactory postoperative outcomes.
Case summary
A 47-year-old male patient presented with bilateral diplopia after cerebral hemorrhage. Bilateral superior oblique palsy was diagnosed, and double Maddox rod tests confirmed 20° of excyclotorsion in both eyes. After 6 months of observation, surgical correction was attempted. To check the amount of cyclodeviation, a modified Harada–Ito procedure was performed on the superior oblique muscle after marking at the 6 and 12 o'clock positions of the corneal limbus. Following the procedure, a Mendez ring was placed on the limbus to check for the amount of incyclotorsion. Thirty degrees of incyclotorsion was aimed at both eyes, and a 5-mm resection of the right superior oblique tendon was performed for additional correction. There was no complaint of diplopia at 6 months postoperatively, and no deviation was observed.
Conclusions
A modified Harada-Ito procedure with intraoperative adjustment using a Mendez ring effectively corrected excyclotorsion with torsional diplopia.

Keyword

Cranial nerve injury; Trochlear nerve palsy; Intraoperative adjustment; Harada-Ito surgery