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Squint Free Papers 3. Losseff S. Ocular findings in cerebral palsy. Am J Ophthalmol 1962;54:1114-8. 4. Hiles DA, Wallar PH, McFarlane F. Current concepts in the management of strabismus in children with cerebral palsy. Ann Ophthalmol 1975;7:789-98. 5. Buckley E, Seaber JH. Dyskinetic strabismus as a sign of cerebral palsy. Am J Ophtalmol 1981;91:652-7. 6. Buckley E, Seaber JH. Unique ocular findings in cerebral palsy patients with strabismus. Am Orthop J. 1981;31:53-9. 7. Bankes JLK, Thornhill DM, Corr PE, et al. The management and binocular achievement of mentally handicapped children with squint. In: Moore S, Mein J, Stockbridge L, editors. Orthoptics: past, present, future. New York: Grune and Stratton; 1976. p. 293-8. 8. Yahalom C, Mechoulam H, Cohen E, Anteby I. Strabismus surgery outcome among children and young adults with Down syndrome. J AAPOS 2010;14:117-9 9. Pickering JD, Simon JW, Lininger LL, et al. Exaggerated effect of bilateral medial rectus recession in developmentally delayed children. J Pediatr Ophthalmol Strabismus 1994;31:374-7. 10. Pickering JD, Simon JW, Ratliff CD, et al. Alignment Success following medial rectus recessions in normal and delayed children. J Pediatr Ophthalmol Strabismus 1995;32:225-7. 11. Ruttum MS, Kivlin JD, Hong P. Outcome of surgery for esotropia in children with Down Syndrome. Am Orthoptic J 2004;54:98-101. 12. Zohar Habot-Wilner, Abraham Spierer, Joseph Glovinsky, and Tamara Wygnanski-Jaffe. Bilateral Medial Rectus Muscle Recession: Results in Children With Developmental Delay Compared With Normally Developed Children MD J AAPOS 2006;10:150-4. Unilateral Vs Bilateral LR Recession in Divergent Excess Type of Small Angle IDS - 4 Year Follow-up Dr. Kamlesh, Dr. Shilpa Goel, Dr. Yuvika Bansal, Dr. Manav Sachdev The traditional treatment for intermittent exortropia has been a bilateral rectus recession or a unilateral lateral rectus recession combined with a medial rectus resection. The use of single lateral rectus muscle recession has been controversial. Many Surgeons avoid using this technique on lateral rectus muscle because of concern that it may produce lateral incommittance and abduction deficits. Although some authors report unilateral recessions as ineffective or producing inconsistent results, the approach has been found to be successful for deviations of 20 PD or less. We have found this procedure to be useful in deviation less than 25 PD. The advantage of unilateral lateral rectus recession for this 827
828 70th AIOC Proceedings, Cochin 2012 disorder includes limiting the risk of surgery to one eye, lower incidence of overcorrection, little change in their alignment from the early post-operative period and shorter duration of anesthesia. The purpose of this study was to compare the surgical and functional outcome of unilateral and bilateral rectus recession in the treatment of divergence excess type of small angle exotropia. MATERIALS AND METHODS 100 patients with intermittent exotropia less than 25 PD were enrolled for this study. Criteria for enrollment were: Divergence excess type of intermittent exotropia (a) with devialtion less than 25 PD (b) best corrected VA>= 6/9. (c) no A or V Pattern (d) No history of previous strabismus surgery. (e) full preoperative duction and version. The patients were randomly divided into two groups of 50 each. Group A underwent unilateral rectus recession and Group B underwent bilateral lateral rectus recession. Measurment were taken at 6m for distance and 30 cm for near deviation after patching one eye for 24 hrs in primary position and in 30 degree side gaze for lateral incomittance. Side gaze measurement was made by rotating the face an estimated 30 degree and having the patient to look forward. Biocular status of the patient was assessed by worth 4 dot test and synaptophore. Corneal topography was done both preoperatively and postoperatively to compare any change in refractive states. All surgeries were performed by conventional hangback technique by one surgeon. The decision on the amount of lateral rectus recession was taken on an individual basis keeping in mind the preoperative factors influencing the outcome of surgery, in each case following the guidelines described by strabismologist. Table 1: Guidelines for Lateral Rectus Recession Surgery PD Group A Group B 15 7 mm 4 mm 20 8 mm 5 mm 25 9 mm 6 mm A satisfactory result was considered when the alignment is within 8 PD of orthophoria. An incommitant postoperative result was considered present, when alignment changed for more than 20% greater from primary to lateral side. RESULTS The mean age of the patients at the time of surgery was 9.60+-4.79 in Group A and 9.93+-4.71 yrs in Group B. The preoperative mean angle in Group A for
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