Clinical Characteristics and Treatment of Esotropia Following Bare Sclera Pterygium Surgery

Ho Jo Seong; Eun Lee Ji; Young Choi Hee; Ho Jung Jae

doi:10.3341/jkos.2013.54.5.771

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Seong, Ji, Hee, and Jae: Clinical Characteristics and Treatment of Esotropia Following Bare Sclera Pterygium Surgery

Original Article

J Korean Ophthalmol Soc 2013;54(5):771-776.

Published online: 7 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.5.771

Clinical Characteristics and Treatment of Esotropia Following Bare Sclera Pterygium Surgery

Ho Jo Seong, MD¹, Eun Lee Ji, MD, PhD¹, Young Choi Hee, MD, PhD², Ho Jung Jae, MD, PhD¹

¹Department of Ophthalmology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine¹, Yangsan, Korea

²Department of Ophthalmology, Pusan National University Hospital, Pusan National University School of Medicine², Busan, Korea

Address reprint requests to Jae Ho Jung, MD, PhD Department of Ophthalmology, Pusan National University Yangsan Hospital #20 Geumo-ro, Mulgeum-eup, Yangsan 626-770, Korea Tel: 82-55-360-2494, Fax: 82-55-360-2161, E-mail: jaeho0130@naver.com

Received 13 July 201213 October 2012 Accepted 25 February 2013

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

The clinical features of esotropia after bare scleral pterygium surgery and dipolpia treatment results were eval-uated in the present study.

Methods

Twenty eyes of 12 patients who had esotropia after bare sclera pterygium surgery from 2008 to 2011 were retro-spectively investigated.

Results

Diplopia occurred at 2.8 ± 1.6 months (1-6 months) after pterygium surgery. The mean pre-operative angle of eso-tropia was 19.4 ± 8.9 PD (8-40 PD) at distance and 16 ± 7.3 PD (0-30 PD) at near. All patients showed limitation of abduc-tion in the pterygium operated eye. Two patients were prescribed prism glasses, 2 patients underwent conjunctiva surgery, and medial rectus recession with simultaneous intraoperative adjustment surgery was performed in 8 patients. An addi-tional strabismus operation was required for 2 patients who received conjunctival surgery due to diplopia recurrence. Seven patients (70%) showed orthotropia at 3 months.

Conclusions

In this study, diplopia following postoperative adhesion caused by bare sclera pterygium surgery technique was observed. Conjunctiva-perimuscular scar tissue removal and medial rectus recession were effective methods in elimi-nating diplopia.

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Keywords: Adhesion, Esotropia, Pterygium surgery, Recession

References

1. Kim JH, Lee JE, Lee JS. Superior-inferior sliding conjunctival flap for pterygium with a Fibrin tissue adhesive (Tisseel(R)). J Korean Ophthalmol Soc. 2006; 47:2041–6.

2. Cho Y. The treatment of esodeviation with abduction deficiency caused by recurrent pterygium. J Korean Ophthalmol Soc. 1991; 32:1110–5.

3. Ela-Dalman N, Velez FG, Rosenbaum AL. Incomitant esotropia following pterygium excision surgery. Arch Ophthalmol. 2007; 125:369–73.

4. Xia Q, Huang Z, Shen DA, Dai H. Clinical analysis of the diplopia and strabismus after ophthalmic surgeries. Zhonghua Yan Ke Za Zhi. 2003; 39:727–30.

5. Jenkins PF, Stavis MI, Jenkins DE 3rd. Esotropia following ptery-gium surgery. Binocul Vis Strabismus Q. 2002; 17:227–8.

6. Raab EL, Metz HS, Ellis FD. Medial rectus injury after pterygium excision. Arch Ophthalmol. 1989; 107:1428.

7. Ugrin MC, Molinari A. Disinsertion of the medial rectus following pterygium surgery: signs and management. Strabismus. 1999; 7:147–52.

8. Miyai T, Hara R, Nejima R, et al. Limbal allograft, amniotic mem-brane transplantation, and intraoperative mitomycin C for re-current pterygium. Ophthalmology. 2005; 112:1263–7.

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Figure 1.

(A) Note clear bare sclera bed and non-significant conjunctival cicatrical changes in ocular surface (white arrow). (B) Extensive fibro-vascular scar formation in pterygium excision surgery area (Black arrow).

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Figure 2.

(A) Preoperative photograph of patient number 6. (B) The postoperative photograph shows orthotropia after bilateral me-dial rectus muscle recession with left medial rectus muscle intraoperative adjustment.

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Figure 3.

(A) Preoperative photograph of patient. The patient shows orthotropia at 1 month after conjunctiva scar revision with amniotic membrane graft surgery. (B) 3 months after conjunctiva surgery combined with amniotic membrane graft, diplopia recurred. (C) Postoperative photograph of patient. The patient shows orthotropia after medial rectus recession surgery.

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Table 1.

Summary of clinical data of patients

No	Age/Sex	Op Side	Op method	Onset of Diplopia	Pre Op Alignment	1 st Tx	2nd Tx	Final Alignment
1	F/55	OD	B	1M	RET 20 PD	OD C^* + AG^‡	S^†	Ortho
2	F/53	OD	B, OD Re op	1M	RET 12 PD	P		ET 12 PD
3	M/39	OS	B, OS Re op	2M	LET 25 PD	OS S^† + AM		Ortho
4	F/51	OU	B, OD Re op	3M	RET 14 PD	OD S^† + AG^‡		Ortho
5	M/52	OU	B, OU Re op	3M	ET 30 PD	OU S^† + AM		Ortho
6	M/53	OU	B, OU Re op	2M	LET 40 PD	OU S^†	P	ET 8 PD
7	M/56	OU	B	6M	RET 12 PD	OD C^* + AM	OD S^†	ET 6 PD
8	M/59	OU	B	3M	RET 16 PD	OD S^†		Ortho
9	M/59	OU	B	4M	LET 20 PD	OS S^†		ET 6 PD
10	M/51	OU	B	1M	LET 16 PD	OS S^†		Ortho
11	M/58	OU	B	3M	ET 8 PD	P		ET 8 PD
12	M/42	OS	B, OS Re op	5M	LET 20 PD	OS S^† + AG^‡		Ortho

Bare = bare sclera technique; Re op = pterygium re-operation; AM = amniotic membrane graft; P = prism glass; PD = prism diopter; ET = esotropia; Ortho = orthotropia.

^* Only conjunctiva surgery (scar removal and conjunctiva-plasty)

^† Medial rectus recession and intraoperative adjustment

^‡ Conjunctiva auto-graft.

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