Journal of American Association for Pediatric Ophthalmology and Strabismus
Major ArticleSurgical management of clinically significant hypertropia associated with exotropia
Section snippets
Methods
A retrospective case cohort series was conducted of 35 patients obtained from the patient registry at the University of Wisconsin–Madison. Patients were included in the study if they were diagnosed with exotropia (including intermittent exotropia) and a hypertropia and underwent a vertical offset of the horizontal muscles or horizontal surgery in combination with vertical rectus muscle surgery. Seven of these patients were diagnosed with exotropia and hypertropia but did not undergo vertical
Results
Charts of 35 patients were available for analysis, and 6-month postoperative data were available in 29 patients (83%) and, in the remaining 6 patients, the 5-week postoperative data were used. Patient age ranged from 1 to 84 years.
Of the 35 patients with exotropia, 10 patients carried the diagnosis of intermittent exotropia, 2 of these 10 had convergence insufficiency type, 18 patients had consecutive exotropia, 4 patients had constant exotropia, 2 had congenital exotropia, and 1 had cerebral
Discussion
The treatment of a constant small-angle vertical tropia associated with exotropia and unrelated to oblique dysfunction, paretic muscle, or DVD has been enigmatic. Pratt-Johnson and Tillson10 have stated that there is no advantage in eliminating a vertical component of 5Δ or less. Moore and Stockbridge's study11 described the coincidental finding of spontaneous resolution of the vertical tropia during prism adaptation for the horizontal deviation alone in intermittent exotropes. The potential
Literature Search
The National Library of Medicine's database was searched through PubMed and MEDLINE for all years with the search terms: vertical transposition of horizontal recti; vertical offset of horizontal recti, exotropia AND vertical; exotropia (all) AND hypertropia (title and abstract). Additionally the core clinical journals for human literature were searched for exotropia AND hypertropia AND NOT superior oblique palsy. Additional sources included the identical search terms in the database of the
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2020, Journal of AAPOSResolution of hypertropia with correction of consecutive horizontal deviation
2017, Journal of the Chinese Medical AssociationCitation Excerpt :Only if hypertropia does not resolve should vertical alignment be undertaken. Our study confirms that horizontal muscle surgery alone can lead to resolution of hypertropia in association with consecutive horizontal strabismus.9 MRI was not used in this study, but may be helpful in future studies to find a probable mechanism for our findings.
Inferior displacement of the lateral rectus muscle insertion in exotropia with mild V-pattern or vertical deviation
2024, Graefe's Archive for Clinical and Experimental OphthalmologyEffect of vertical transposition of the horizontal muscles on vertical strabismus associated with exotropia
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