Treatment of incomitant hypertropia and diplopia with recession of the inferior rectus and superior rectus muscles of the same eye
Received 2 March 2006; accepted 24 February 2007.
Purpose
To evaluate the effectiveness of recession of the inferior rectus (IR) and superior rectus (SR) muscles of the same eye in the treatment of incomitant hypertropia with diplopia.
Methods
Retrospective record review of two groups. (1) Patients with hypertropia and diplopia in downgaze and with fusion in the primary position underwent adjustable recessions of the IR and SR muscles of the eye that was hypotropic in downgaze. (2) Patients with hypertropia and diplopia in the primary position and less hypertropia in downgaze underwent an IR muscle recession of the hypotropic eye in the primary position and adjustable recessions of the contralateral IR and SR muscles.
Results
Group 1 included four patients. Mean incomitance between primary position and downgaze was 10Δ. After mean follow-up of 44 months, all patients were fusing in the primary position and downgaze. Group 2 included six patients. Mean incomitance between primary position and downgaze was 9.3Δ. After mean follow-up of 40 months, all patients were fusing in the primary position and downgaze. One patient in group 2 required a second procedure.
Conclusions
Recession of both vertical rectus muscles of the same eye appears to be an effective, stable, and predictable procedure for patients with incomitant hypertropia with diplopia in downgaze. A modification of this procedure may also be effective for cases in which postoperative hypertropia in downgaze is anticipated with recession of one IR muscle. The procedure is especially appropriate in the treatment of thyroid eye disease, since it is adjustable, and since it does not require resection or posterior fixation of a vertical rectus muscle.
Department of Ophthalmology, Louisiana State University School of Medicine, New Orleans, Louisiana
Reprint requests: Bradley C. Black, MD, 5220 Flanders Drive, Baton Rouge, LA 70808.
This study was conducted at The Pediatric Eye Care Center, Baton Rouge, Louisiana.
ABSTRACT