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Hong, Rhiu, Chang, Chang, and Lee: Intraoperative Adjustment in Horizontal Strabismus Surgery Using Corneal Reflex
Original Article

J Korean Ophthalmol Soc 2008;49(1):143-147.

Published online: 3 August 2008

DOI: https://doi.org/10.3341/jkos.2008.49.1.143

Intraoperative Adjustment in Horizontal Strabismus Surgery Using Corneal Reflex

Jin Pyo Hong, M.D.1, Soo Lie Nah Rhiu, M.D.1, Yoon Hee Chang, M.D.2, Jee Ho Chang, M.D.3, Jong Bok Lee, M.D.1

1The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea

2Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea

3Department of Ophthalmology, College of Medicine, Soonchunhyang University, Bucheon, Korea

Address reprint requests to Jong Bok Lee, M.D. Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine #134 Shinchon-dong, Seodaemun-gu, Seoul 120-752, Korea Tel: 82-2-2228-3770, Fax: 82-2-312-0541, E-mail: 491209@yumc.yonsei.ac.kr

Received 4 January 2007       Accepted 28 August 2007

Copyright © 2008 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Using corneal reflex, we performed intraoperative adjustments in horizontal strabismus patients who had very poor visual acuities with good compliance and analyzed various aspects of intraoperative adjustment.

Methods

We retrospectively reviewed the records of patients with horizontal strabismus who underwent intraoperative adjustment using corneal reflex from May 1997 to April 2005. We evaluated various aspects of intraoperative adjustment.

Results

Fifty-five patients (40 exotropes, 15 esotropes) were included in our study. 11 of 40 extropes (27.5%) and 4 of 15 esotropes (26.7%) eventually underwent operations that were adjusted intraoperatively. Successful results were seen in 35 of 40 exotropes (87.5%) and 8 of 15 esotropes (53.3%). Fifteen patients (27.3%) received intraoperative adjustments, and of these patients 11 (20.0%) who had successful results would have experienced either undercorrection or overcorrection if their operation were performed as scheduled. Four patients underwent operation on one muscle rather than on the scheduled two muscles. All 4 of these patients (100%) would have experienced significantly large overcorrection had they not received intraoperative adjustment.

Conclusions

Patients who would have had difficulty with fixation due to low visual acuity could avoid under- or overcorrection and are expected to have higher success rates because of intraoperative adjustment using corneal reflex.

Keywords: Corneal reflex, Horizontal strabismus, Intraoperative adjustment

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Table 1.
Demographics of patients and the scheduled operation
Exotropia (40) Esotropia (15)
Sex (M:F) 22:18 7:8
Mean age (years) 34.4 (20-68) 40.7 (28-62)
Mean angle of deviation (Δ) 38.5 (20-50) 33.9 (16-50)
Mean duration of follow up (months) 8.8 (6-18) 8.0 (6-18)
Table 2.
Number of patients with less than 10 PD deviations at last visit (success rate)
Types of Modification Number of patients (%)
Exotropia (40) Esotropia (15)
Modification by intraoperative adjustment 9/11 (81.8%) 2/4 (50.0%)
No modification by intraoperative adjustment 26/29 (89.7%) 6/11 (54.5%)
Total 35/40 (87.5%) 8/15 (53.3%)
Table 3.
Modifications of the operation amount in patients with successful results
Modification of operation amount Number of patients (%)
Exotropia (40) Esotropia (15)
Increased 1/2 (50.0%) -
Decreased 6/7 (85.7%) 0/2 (0.0%)
Changed to one muscle operation 2/2 (100%) 2/2 (100%)
Total 9/11 2/4
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