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Author Spotlight: Advancements in Refractive Surgical Correction for Presbyopia and Exploring Postoperative Visual Acuity
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The Effect of Horizontal Rectus Muscle Surgery on Distance-Near Incomitance.

Paul H Phillips1, Katherine J Fray1, A Paula Grigorian1

  • 1Department of Ophthalmology, Arkansas Children's Hospital, Little Rock, Arkansas, USA; Department of Ophthalmology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.

American Journal of Ophthalmology
|November 27, 2019
PubMed
Summary
This summary is machine-generated.

Horizontal rectus muscle surgery does not significantly alter distance-near incomitance. Medial or lateral rectus surgery has no greater effect on ocular alignment at specific distances, challenging traditional views.

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Area of Science:

  • Ophthalmology
  • Strabismus Surgery
  • Ocular Motility

Background:

  • Distance-near incomitance, a condition affecting binocular vision, can be influenced by extraocular muscle surgery.
  • Traditional surgical approaches often consider potential impacts on incomitance at different viewing distances.

Purpose of the Study:

  • To investigate the effect of horizontal rectus muscle surgery on distance-near incomitance.
  • To determine if medial or lateral rectus muscle surgery differentially impacts ocular alignment at distance versus near fixation.

Main Methods:

  • A prospective, comparative, interventional case series evaluated patients over 7 years old undergoing medial or lateral rectus muscle surgery.
  • Distance-near incomitance was measured using prism and alternate cover testing at 6m and 0.3m preoperatively and postoperatively (within 1 week and ~1 year).
  • Patients with extraocular muscle fibrosis or paralysis were excluded from the study.

Main Results:

  • Forty-five patients (25 medial rectus, 20 lateral rectus surgery) were included.
  • Postoperative distance-near incomitance showed no clinically significant change (≤10 prism diopters) in most patients within 1 week and all patients at long-term follow-up.
  • Horizontal rectus muscle surgery did not induce a significant change in distance-near incomitance (±2 PD equivalence, P=0.014).

Conclusions:

  • Horizontal rectus muscle surgery does not produce a clinically significant effect on distance-near incomitance.
  • Contrary to traditional beliefs, medial rectus surgery did not disproportionately affect near fixation, nor did lateral rectus surgery affect distance fixation.
  • Distance-near incomitance does not need to be a primary consideration when selecting between medial and lateral rectus muscle surgery.