Surgical success and lateral incomitance following three-muscle surgery for large-angle horizontal strabismus.

Journal Article (Journal Article)

PURPOSE: To evaluate motor alignment, motility, and sensorial outcomes of simultaneous three-muscle surgery for large-angle horizontal strabismus, with special attention to lateral incomitance and long-term success. METHODS: The medical records of consecutive patients with large-angle deviations (≥30Δ) who underwent simultaneous surgery on three horizontal muscles to correct esotropia or exotropia were reviewed retrospectively. Successful motor alignment was defined as residual deviation of ≤10Δ and consecutive deviation in primary position of ≤4Δ, with no induced lateral incomitance >5Δ between lateral gazes. Sensory success was defined as an improvement in stereopsis of ≥2 octaves. Surgical procedures included a combination of recessions and resections/plications depending on surgeon preference. The majority of cases were two-muscle recessions combined with one-muscle resection or plication. RESULTS: A total of 19 patients with exotropia and 9 patients with esotropia were included. In the esotropic group, the mean age at surgery was 48 ± 15 years and the mean preoperative deviation improved from 45.6Δ ± 11.9Δ to 1.5Δ ± 1.6Δ (P < 0.001); there was no undercorrection, recurrence or overcorrection. In the exotropic group, the mean age at surgery was 44 ± 25 years, and the mean preoperative deviation improved from 44.1Δ ± 8.7Δ to 5.8Δ ± 9.6Δ (P < 0.001), recurrence occurred in 2 (22%). Overall motor success at distance was 85%, with 1 (3.8%) unsuccessful patient due to induced incomitance. Sensory success was 44% for esotropia and 31% for exotropia. No patient lost stereopsis. CONCLUSIONS: Patients undergoing three-muscle surgery for horizontal strabismus had good motor outcomes with low incidence of induced lateral incomitance. Motor and sensorial outcomes for esotropia were very stable.

Full Text

Duke Authors

Cited Authors

  • Cifuentes, DL; Pineles, SL; Demer, JL; Velez, FG

Published Date

  • February 2018

Published In

Volume / Issue

  • 22 / 1

Start / End Page

  • 17 - 21

PubMed ID

  • 29199031

Pubmed Central ID

  • PMC6596295

Electronic International Standard Serial Number (EISSN)

  • 1528-3933

Digital Object Identifier (DOI)

  • 10.1016/j.jaapos.2017.10.005


  • eng

Conference Location

  • United States