Unwinding of Cyclodeviation After an Adjustable Harada-Ito Procedure
Laura Liebermann; David A. Leske; Sarah R. Hatt; Bashar Bata; Jonathan M. Holmes
Introduction: Harada-Ito disinsertion and advancement of the anterior fibers of the superior oblique tendon is commonly performed for torsional diplopia due to excyclotropia, but there are few data on regression of its effect.
Methods: We identified 45 patients who had undergone unilateral adjustable Harada-Ito surgery with adjustment the same day and assessed cyclodeviation (using the double Maddox rod test) at post-adjustment, one day, 6 weeks, 1 year, and 5 years postoperatively. We calculated change in cyclodeviation from postadjustment. Unwinding was defined as reduction of incyclodeviation or increase in excyclodeviation.
Results: Mean preoperative excyclodeviation was 8.9°±3.4°SD. Post Harada-Ito, the mean unwinding was 3.1°±2.3° between post-adjustment and day 1, and 3.3°±2.2° between day 1 and 6 weeks. Unwinding continued after 6 weeks, but at a slower rate with a mean change of 0.4°±2.9° between 6 weeks and 1 year (n=33) and of 1.9°±3.1° between 1 year and 5 years (n=7). Total unwinding was 6.4°±2.6° at 6 weeks, 6.5°±3.2° at 1 year and 7.4°±1.8° at 5 years. There was no relationship between preoperative excyclodeviation and amount of unwinding at 6 weeks (r=0.13231, P=0.4). There was a strong relationship (r=-0.72521, P<0.0001) between postadjustment cyclodeviation and amount of unwinding at 6 weeks, but even those with no cyclodeviation at postadjustment unwound a mean of 4.3°±2.1°.
Discussion: The effect of Harada-Ito surgery regresses over time.
Conclusion: When performing same-day adjustable Harada-Ito surgery, an immediate postadjustment target angle of 7° to 10° incyclodeviation is reasonable.