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Clinical Trial
. 2004:102:169-75; discussion 175-6.

Graded partial tenotomy of vertical rectus muscles for treatment of hypertropia

Hye Bin Yim  1 , Albert W Biglan, Tara H Cronin
Affiliations
Clinical Trial

Graded partial tenotomy of vertical rectus muscles for treatment of hypertropia

Hye Bin Yim et al. Trans Am Ophthalmol Soc. 2004.

Abstract

Purpose: To evaluate the effectiveness of graded (adjustable intraoperatively) partial vertical rectus muscle tenotomy at the insertion in correcting small degrees of hypertropia.

Methods: All patients with best-corrected visual acuity of better than 6/30 in both eyes who over a 30-month period underwent partial tenotomy of vertical rectus muscle(s) only (no concurrent oblique muscles) were included. Improvement was evaluated 6 weeks postoperatively as change in alignment in prism diopters (PD) in primary gaze and in the field of action of the affected rectus muscle(s). Binocular function was evaluated by Titmus stereoacuity and the Worth 4-light tests.

Results: All 24 patients who met criteria for inclusion had diplopia preoperatively versus seven patients (29%) postoperatively (P < .005, Student's paired t test). Prisms were used by six preoperatively versus two postoperatively (P < .05, Student's paired t test). The average vertical deviation in primary gaze decreased from 8 PD to 2 PD (P < .005, Student's paired t test). In the field of action of the treated rectus muscle, hypertropia decreased from an average of 8 PD to 3 PD (P < .005, Student's paired t test). For the preoperative and the postoperative assessments available, stereoacuity improved after 10 (56%) of the 18 procedures and Worth 4-light testing showed improvement or maintenance of fusion after 15 (79%) of 19 procedures.

Conclusions: Graded vertical rectus partial tenotomy can effectively reduce small degrees of hypertropia and associated diplopia, improve binocular function, and reduce or eliminate the need for prism correction.

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Figures

Figure 1
Figure 1
Drawing showing procedure for graded partial tenotomy of vertical rectus muscle for treatment of hypertropia. With the patient under moderate sedation, the superior rectus is exposed, the tendon is cauterized near its insertion, and a Westcott scissors is used to make a cut in the tendon. The patient is tested with eyeglasses (without prisms), and if correction of vertical deviation is inadequate, the tenotomy is extended successively until the desired effect is achieved.
See this image and copyright information in PMC

References

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