Post operative
Someone whose squint
alternates is very unlikely to develop amblyopia
because both eyes will receive equal visual
stimulation, like this lady whose VA is 20/20 OU .
Most patients I've met with this type of XT have a
huge angle of deviation and very ugly appearance
, they always ask for surgery to realign their eyes
. In most cases 3 muscles - or even four
muscles -
surgery
is needed .
In these patients fixating with both eyes ,
measuring the angle with prism and cover test is
usually could be done easily . Angle measured here
is 85-90 PD , surgery done here is BLR recession 8mm
and Lt MR resection mm . She was satisfied
with the result.
Many surgeons fear of diplopia which may occur
post-operative in these cases , although I rarely
met this post-operative complaint , but if it
happens , alternating day occlusion for 1 or 2 weeks
is enough for such complaint to disappear .
This is a useful table for surgical ‘numbers’ I
follow in alternating XT
Bilateral lateral rectus recession
5.0 mm OU/20-25 prism diopters
6.0 mm OU/25-30 prism diopters
7.0 mm OU/30-40 prism diopters
8.0 mm OU/40-50 prism diopters
Recession lateral rectus--resection medial rectus
5.0 mm--*5.0 mm/20-25 prism diopters
6.0 mm--*6.0 mm/25-30 prism diopters
7.0 mm--*8.0 mm/30-40 prism diopters
8.0 mm--*10.0 mm/40-50 prism diopters
Three-muscle surgery
8.0 mm--*6.0 mm--8.0 mm/50-60 prism diopters
8.0 mm--*8.0 mm--8.0 mm/60-75 prism diopters
Four-muscle surgery
8.0 mm--*8.0 mm--*8mm--*8.0mm/70-85prism
diopters
8.0 mm--*10.0 mm--10.0 mm--8.0 mm/85-100 prism
diopters
*This is just a
place to start. Each surgeon’s numbers must be his
or her own
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