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Surgical management of skew deviation
R Michael Siatkowski1, Robert F Sanke, Bradley K Farris
1Dean A. McGee Eye Institute, Department of Ophthalmology, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma 73104, USA. Rmichael-siatkowski@ouhsc.edu
Summary
Realignment surgery for skew deviation effectively relieved double vision in most patients. Vertical rectus muscle procedures were most common, though some required multiple surgeries.
Area of Science:
- Ophthalmology
- Strabismus Surgery
Background:
- Skew deviation is a complex binocular vision disorder.
- Published data on surgical outcomes for skew deviation are lacking.
Purpose of the Study:
- To evaluate the outcomes of surgical correction for skew deviation.
- To identify effective surgical techniques for skew deviation.
Main Methods:
- Retrospective chart review of 10 patients undergoing skew deviation surgery.
- Procedures performed by three surgeons at a single institution (1991-2002).
Main Results:
- Nine of 10 patients achieved satisfactory relief of diplopia and single binocular vision.
- Vertical rectus muscle surgery (recession or resection) was the most frequent procedure.
- Four patients needed more than one surgical intervention.
- Inferior rectus muscle resection or superior rectus muscle recession succeeded in nonalternating hypertropias.
- Bilateral inferior rectus muscle resection was effective for alternating hypertropia.
- Oblique muscle surgery yielded poor outcomes.
Conclusions:
- Realignment surgery, particularly involving vertical rectus muscles, is effective for managing skew deviation.
- Specific vertical muscle techniques show success in different types of hypertropia.
- Oblique muscle surgery should be avoided for skew deviation correction.