Year : 1983 | Volume
: 31 | Issue : 7 | Page : 1016--1018
Guarded recession surgical procedure in horizontal concomitant squint surgery
SM Sathe, VG Kane
H.B. Charitable Eye Hospital parel Mumbai, India
S M Sathe
KB.H.B. Charitable Eye Hospital, Parel, Mumbai
|How to cite this article:|
Sathe S M, Kane V G. Guarded recession surgical procedure in horizontal concomitant squint surgery.Indian J Ophthalmol 1983;31:1016-1018
|How to cite this URL:|
Sathe S M, Kane V G. Guarded recession surgical procedure in horizontal concomitant squint surgery. Indian J Ophthalmol [serial online] 1983 [cited 2021 Jun 17 ];31:1016-1018
Available from: https://www.ijo.in/text.asp?1983/31/7/1016/29733
In cases of concomitant horizontal squint guarded recession of the overacting synergists is advised to obtain visual alignment. It is a simple and safe procedure allowing both the motor and sensory mechanisms to play their role in maintaining the visual alignment after the surgery. The aim of achieving the visual alignment in one single surgical procedure is also achieved in 90% of cases.
MATERIALS AND METHOD
All the cases were examined on synoptophore and necessary refraction, occlusion and orthoptic treatment was carried out so as to achieve almost equal vision in both the eyes. Irrespective of degree of squint, in cases of concomitant convergent squint both the medial recti and in cases of concomitant divergent squint both the lateral recti were recessed. Cases were followed for a period of 4 months to 4 years.
- Anaesthesia General or local.
- Muscle is exposed by conjunctival incision 5 min from the limbus.
- Muscle is separated from its attachment.
-Two whip stiches were taken with 5'0 chromic catgut at the upper & lower edges of the muscle near the insertion.
- Muscle is cut away from the insertion and allowed to retract Sutures are not anchored (to the sclera) but are brought out of conjunctival incision and left loose. Conjunctiva is sutured with 6'0 black silk. (Interrupted sutures)
Irrespective of degree of squint in concomitant convergent squint both the medial recti and in cases of concomitant divergent squint both the lateral recti were tackled.
As soon as the patient is out of anaesthetia, eyes are left open and patient is allowed to use the glasses arlready prescribed.
1) 27 cases were corrected without residual squint.
2) 3 cases were left with residual squint of 5 to 10 degrees.
3) Not a single case was overcorrected.
4) Movements including convergence were normal
In squint surgery it is difficult to obtain visual alignment by a single surgery as the problem does not remain only mechanical one.
The extraocular muscles, that one has to tackle is not a fixed structure but is a dynamic structure with the property of elasticity varying from person to person and eye to eye. Today we are lacking in the knowledge of ways to assess the elastic property of a muscle and decide whether it is a good rubber band or a piece of leather.
Action of a muscle depends upon
A) Anatomical factors:- Length and breadth of a muscle, size of the eye ball, etc.
B) Sensory factors:- The inward and outward impulses concerning the entire visual apparatus both monocular and binocular.
The binocular mechanism is a powerful one as seen in a case of phoria where the visual axis is maintained parellal over long periods going into tropia.
Once this concept is understood one can understand that at present while doing squint surgery only motor mechanism is taken into account neglecting the sensory mechanism. Hence with millimeter surgery it is difficult to predict the amount of correction that can be obtained in a given case.
That is where an experienced surgeon scores by altering the plan of surgery on the table. With all this one can understand why the statements regarding the amousnt of correction of squint obtained by recession or resection of a muscle vary from text book to text book.
In the above procedure as muscle is in no way fixed to the sclera and eyes are left open in shortest possible time bincoular reflex mechanism (which maintain the parallelism in orthophoric people) is again allowed to act without any mechanical hindrance.
We have attempted to do a correction without anchorage (sutures to maintain the direction of muscle and its contact with sclera.), helping binocular mechanism to have and uninhibited scope to exert its own effect and help the eyes to bring the parallelism by balancing the muscle-actions between weaker and stronger forces.
1) Guarded recession is a simple and safe procedure.
2) It appears from present study that it is without any overcorrection and with 90% success.
3) Postoperative movements including convergence were normal.
4) In conventional squint surgery only the motor mechanism is tackled. In the above procedure even the sensory mechanism (binocular reflexes) are allowed to play their role in squint correction by keeping the eyes open soon after the surgery.
|1||Jampolsky,A..1978.Acljustablestrabismus surgical procedures, Symposium on strabismus, THE C.V. MOSBY COMPANY.|
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|3||T. Keith Lyle. C.B.E., 1950, Worth & Chavasse's SQUINT, 8th edition BAILLIERS, TINDALL & COX|