Changes of anterior segment parameters after horizontal rectus muscles recession versus resection (original) (raw)
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Changes of anterior segment parameters after horizontal rectus20200319 9551 1vr3aw
Background: To record the corneal, and anterior chamber depth changes after performing recession versus resection of horizontal recti muscles. Methods: Consecutive patients who underwent isolated lateral rectus muscle recession or resection February 2014 to January 2015 were prospectively studied. Refractive error (spherical equivalent); K1, K2, and mean k reading, anterior and posterior corneal elevation; and anterior chamber depth were measured (Pentacam) before, 1 month, and 3 months after surgery. Patients who could not maintain reliable fixation and those with a history of eye surgery were excluded. Pre-and postoperative measurements were compared by analysis of variance. Results: A total of 36 eyes of 23 patients (average age, 16 years) were included. Rectus muscle recession was performed in 24 eyes; and resection was performed in 12 eyes. Statistically significant changes in mean keratometry of recession group only. Central anterior elevation, and central anterior chamber depth were significant when both groups are compared at first month after surgery. Changes became regressive at the end of the third month. Although a significant change of central anterior elevation persisted. Conclusions: In recession group, the mean K was the only statistically significant variable by the first postoperative month. Comparing the both groups, the anterior corneal elevation, and central anterior chamber depth revealed a significant difference by the end of the first postoperative month. After 3 months, all parameters showed a statistical insignificant difference between the recession and resection groups except the anterior corneal elevation.
Cureus
The aim of the study was to evaluate the long-term effect of large horizontal rectus muscle recession on macula thickness using spectral domain optical coherence tomography (SD-OCT). Material and methods Forty-two children were included in the study. The intervention groups were the medial rectus (MR) group (=20 eyes) and the lateral rectus (LR) group (=22 eyes), including the eyes that underwent large medial and lateral rectus muscle recession, respectively. The control group included the fellow 42 unoperated eyes of the same children. Each eye was scanned using Topcon Maestro2 OCT-Angiography (OCTA; Topcon, Tokyo, Japan) preoperatively and then two months following surgery. A paired t-test was used to compare the mean difference in macular thickness between the intervention and control groups using the statistical program R (R Foundation for Statistical Computing, Vienna, Austria). Results The mean change in central, parafoveal, and perifoveal macular thickness of the intervention group was not statistically significant. Conclusion The long-term changes in macular thickness, as evaluated using SD-OCT both for the central and peripheral regions of the fovea, following large horizontal rectus muscle recession surgery, are not statistically significant.
Minimally invasive strabismus surgery for horizontal rectus muscle reoperations
British Journal of Ophthalmology, 2008
To study if minimally invasive strabismus surgery (MISS) is suitable for rectus muscle reoperations. Methods: The study presents a series of consecutive patients operated on by the same surgeon at Kantonsspital St Gallen, Switzerland with a novel MISS rectus muscle reoperation technique. Surgery is done by applying two small radial cuts along the muscle insertion. Through the tunnel obtained after muscle separation from surrounding tissue, a recession, advancement or plication is performed. Results: In 62 eyes of 51 patients (age 35.4 (SD 16.3) years) a total of 86 horizontal rectus muscles were reoperated. On the average, the patients had 2.1 strabismus surgeries previously. Preoperative logMAR visual acuity was 0.38 (0.82) compared with 0.37 (0.83) at 6 months (p.0.1). On the first postoperative day, in the primary gaze position conjunctival and lid swelling and redness was hardly visible in 11 eyes, discrete in 15 eyes, moderate in 11 eyes and severe in 15 eyes. One corneal dellen and one corneal erosion occurred, which both quickly resolved. The preoperative deviation at distance for esodeviations (n = 15) of 12.5 (8.5)u decreased to 2.6 (7.8)u at 6 months (p,0.001). For near, a decrease from 12.0 (10.1)u to 2.9 (1.6)u was observed (p,0.001). The preoperative deviation at distance for exodeviations (n = 35) of 216.4 (8.5)u decreased to 27.9 (6.5)u at 6 months (p,0.005). For near, a decrease from 216.5 (11.4)u to 22.9 (1.5)u was observed (p,0.005). Within the first 6 months, only one patient had a reoperation. At month 6, in four patients a reoperation was planned or suggested by us because of unsatisfactory alignment. No patient experienced persistent diplopia or necessitated a reoperation because of double vision. Stereovision improved at month 6 compared with preoperatively (p,0.01). Conclusions: The study demonstrates that a small-cut, minimal dissection technique allows to perform rectus muscle reoperations. The MISS technique seems to reduce conjunctival and lid swelling in the direct postoperative period.
Purpose: To compare surgical outcomes and astigmatism induced by Hang-back and conventional recession surgery in horizontal strabismus. Methods: In a randomized, double blind, prospective trial, 40 patients of horizontal strabismus, (18 exotropia and 22 esotropia) were randomized into 2 groups according to the type of recession procedure performed. All ocular examinations were done pre and post-operatively including manual and automated keratometry, assessment of angle of deviation was carried out by a certified orthoptist. All patients were followed for a mean duration of 6 months. Results: Among esotropia success rate (defined as post-operative deviation of < 10 PD 6 months post operatively) was 80 % in patients with Hang-back recession and 84 % in patients with conventional recession (p=1). For exotropia success rate was 60 % in patients with hang-back recession and 75 % among patients of conventional recession (p>0.6). 90 % of eyes operated with conventional recession technique showed significant changes in average keratometry readings (defined as change of > 0.50 D), while for eyes operated by Hang-back technique only 37 % showed same changes (p<0.002). Surgeons comfort score using visual analogue scale was also compared. Conclusion: Hang-back recession is an effective alternative to conventional recession with an added advantage of decreased amounts of surgically induced astigmatism, especially in children with smaller globes, poor exposure and high myopia.
Long-Term Results of Deeper Muscle Fibers Recession of an Inferior Rectus Operation
Journal of Pediatric Ophthalmology & Strabismus, 2013
Purpose: To report the efficacy in preventing lower eyelid retraction and long-term results of a new technique of inferior rectus (IR) recession for vertical strabismus and compare this method with the results obtained by a conventional IR recession operation. Methods: This retrospective study included 35 patients who underwent a new IR recession method (study group) and 22 patients who underwent the conventional IR recession (control group) for vertical strabismus. In the study group, an IR recession was applied to the deeper fibers and included approximately 90% of the IR muscle thickness. This group was divided into two subgroups: small IR recessions (4 to 6 mm) and large IR recessions (7 to 8 mm). In the control group, an IR recession of the entire muscle was applied without exceeding 6 mm. The photographs were analyzed for lower eyelid position. Digital image analysis was used to standardize each patient's preoperative and postoperative photographs at final followup examination. The main outcome measures were the margin-to-reflex distance, lower eyelid retraction, and vertical deviation angles (at near and distance fixation). Results: The mean change in margin-to-reflex distance after surgery was 0.03 mm in the small IR recessions group, 0.1 mm in the large IR recessions group, and 2.04 mm in the control group. Postoperatively, the lower eyelid retraction in the study group, which occurred after both small and large IR recessions, was significantly less than that in the control group (P < .001). There was no significant difference between the study and control groups in improvements in near and distance vertical deviations and success ratios (P > .05). Conclusions: At long-term follow-up, recession of the deeper fibers layer, including approximately 90% of the IR muscle thickness, was a procedure that minimized or eliminated the possibility of lower eyelid retraction and did not limit the success of strabismus surgery.
Astigmatism induced by simultaneous recession of both horizontal rectus muscles
Journal of American Association for Pediatric Ophthalmology and Strabismus, 2003
Purpose: Changes have been reported in the refractive state of the eye after various types of strabismus surgery. This study investigates the effect of large simultaneous recession of both horizontal rectus muscles on the refractive state of the eye. Methods: Twenty-six eyes (13 patients) were refracted 1 to 2 weeks before and 6 to 8 weeks after large horizontal rectus muscle recessions for the purpose of damping nystagmus. The preoperative refraction was mathematically subtracted from the postoperative refraction, and the induced refractive changes were averaged and statistically analyzed. The relation between the amount of recession and the induced astigmatism was also investigated. Results: A statistically significant change in astigmatism in the with-the-rule direction was induced with this procedure (ϩ 0.70 diopter cylinder, axis 90.0°, P Ͻ .0002). With the narrow range of amounts of recession performed, there was no demonstrable relation between the amount of recession and the amount of induced astigmatism. Conclusions: Recession of both horizontal rectus muscles, the same as has been reported for recession of one horizontal rectus muscle and recession-resection surgery on both horizontal rectus muscles, tends to induce a change in astigmatism in the with-the-rule direction.
A paired comparison study on refractive changes after strabismus surgery
Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus, 2018
To quantify refractive changes following horizontal lateral rectus recession and medial rectus resection surgery and to investigate the causes of these changes. Methods The medical records of patients who underwent unilateral horizontal lateral rectus recession and medial rectus resection for exotropia by a single surgeon over a period of 14 years were reviewed retrospectively. Using vector analysis, refractive changes in operated eyes (cases) were compared to changes in the sound eyes (controls). The main outcome measures were differences in mean change of refractive parameters and the proportion of clinically significant changes. Results A total of 31 subjects (median age, 13.6 years; interquartile range, 8.8-19.8 years) were included. A significantly higher magnitude of refractive changes was observed in the operated eyes (P = 0.001). In addition, the proportion of cases with clinically significant change in sphere or cylinder was significantly higher in the operated eyes compared to the sound eyes (48% vs 10% [OR = 2.31, P = 0.002] and 32% vs 10% [OR = 5.0, P = 0.039], resp.). Conclusions Horizontal strabismus surgery is associated with refractive changes that might be of clinical significance. Pediatric ophthalmologists should consider re-refraction 1 month postoperatively.
Evaluation of macular thickness change after inferior oblique muscle recession surgery
Indian Journal of Ophthalmology, 2014
This study aimed to evaluate the changes in macular thickness following inferior oblique muscle recession surgery. Materials and Methods: Thirty-eight eyes from 21 patients undergoing ocular muscle surgery were included. Patients were grouped into three groups based on the type of surgical intervention: Group I (n = 12), inferior oblique recession surgery alone; Group II (n = 12), inferior oblique plus horizontal muscle surgery; Group III (n = 14), horizontal muscle surgery alone. Each eye was scanned using the optical coherence tomography (OCT) device preoperatively and on the first postoperative day to measure macular thickness. Results: Following surgery, a significant increase in foveal thickness occurred in Group I (P < 0.05) and Group II (P < 0.01). In addition, a statistically significant difference was observed between the groups with regard to the increase in foveal thickness (P = 0.016), with significantly lower changes in Group III. Conclusion: Our findings suggested that inferior oblique muscle recession surgery is associated with an increase in macular thickness.
The effect of strabismus muscle surgery on corneal biomechanics
Journal of American Association for Pediatric Ophthalmology and Strabismus
Purpose. Studying the early effect of different extraocular muscle (EOM) surgeries on corneal biomechanics. Subjects and methods. is is a prospective, nonrandomized, interventional study, in which 42 eyes of 29 candidates for EOM surgery for strabismus correction at Cairo university hospitals, aged 14-37 years, were recruited. All participants had measuring of the visual acuity, refraction (spherical equivalent (SE)), assessment of the EOM motility and muscle balance, sensory evaluation, fundus examination, and assessing the ocular biomechanics using the Ocular response analyzer (ORA, Reichert, INC., Depew, NY) noting the corneal hysteresis (CH) and corneal resistance factor (CRF) preoperatively. Same patients were reassessed using ORA 4 weeks postoperatively following a different standard EOM surgery (recti weakening/strengthening and inferior oblique weakening either (graded recession) according to the surgical indication, and ∆CH and ∆CRF were calculated, each is the preoperative − the postoperative value. Results. ∆CH and ∆CRF � −0.78 ± 1.56 and −0.72 ± 2.15, respectively, and a highly significant difference was found between each of the pre-and postoperative CH and CRF (p < 0.001). 18 eyes had single EOM surgery, while 24 had multiple (2 or 3) EOM surgery; ∆CH in the single group � 1.28 1.5, and ∆CH in the multiple group � 0.4 1.49 (p � 0.07). 23 eyes had EOM weakening surgery, while 18 had combined weakening and strengthening EOM surgery: ∆CH in the weakening group � 1.24 1.77 and ∆CH in combined group � 0.26 1.07 (p � 0.04). A nonsignificant difference was found for ∆CRF (p � 0.53). Conclusion. A different EOM surgery has an early tendency for increase of the postoperative CH specially for muscle weakening procedures (recti recession/inferior oblique muscle weakening).
IOSR Journals , 2019
Purpose: To quantify the effects on the anterior segment morphometry and intraocular pressure (IOP) and timing of prescribing of glasses after uneventful small incision cataract surgery (SICS) with intraocular lens implantation in patients normal individuals. Materials and methods: Study included 93 eyes of 93 patients undergoing small incision cataract surgery, followed by posterior chamber intraocular lens implantations (PC IOL). The Pentacam rotating Scheimpflug camera measured the following changes that occurred in the anterior chamber: depth (ACD), angle (ACA), central corneal thickness (CCT) and astigmatism. Additionally, Goldmann applanation tonometry (corrected with Pentacam based) was used to evaluate intraocular pressure (IOP). All measurements were first taken preoperatively and subsequently at 1 st weeks, 4 th weeks and 6 th weeks postoperatively. Results: When measured at 1, 4 and 6 weeks postoperatively, the mean ACD, and ACA increased in all groups (p<0.0001). Astigmatism significantly showed changes up to 4 th week (P=0.0017) and insignificant at 6 th week. The IOP decreased throughout all postoperative periods (p<0.0001). CCT significantly increased in 1 st week (P<0.0001) but latter return to near normal 4 th week (P=0.056) and 6 th week (P=0.814). We found insignificant postoperative pachymetric changes when compared to the preoperative period (p>0.05). Conclusions: Cataract surgery significantly increased ACD and ACA in all individuals. IOP was significantly decreased after surgery, however, there was insignificant changes of CCT. The astigmatism stabilised at 4th to 6th week so glasses can be prescribed in this period.