The long-term torsion effect of the adjustable Harada-Ito procedure.
OBJECTIVE
The Harada-Ito procedure is a widely used technique in the treatment of excyclotorsion. While previous studies have demonstrated its initial success, long-term data have not been readily available. The purpose of this study is to describe the long-term torsion effect of the adjustable Harada-Ito procedure.


METHODS
All Harada-Ito procedures performed by 1 surgeon from 1982 to 1998 with at least 1 year of follow-up were reviewed. Torsion was evaluated using the double Maddox rods preoperatively, 1 day postoperatively, 2 months, 6 months, 1 year, 18 months, then annually thereafter. The effectiveness of the procedure was evaluated by comparing preoperative values to those at follow-up exams. The stability of the procedure was also evaluated by comparing torsion at 1 day and 2 months postoperatively to the torsion at subsequent exams. All comparisons were performed using the Student's t test.


RESULTS
Eighty Harada-Ito procedures were performed by 1 surgeon during this period. Nineteen patients had at least 1 year of follow-up (range, 1-7 years; mean, 2.0 years). Mean excyclotorsion values were 10.7 degrees preoperatively, 1.0 degrees at 1 day, 1.0 degrees at 2 months, 3.4 degrees at 6 months, 4.8 degrees at 1 year, and 5.3 degrees at 18 months. There was a significant improvement of excyclotorsion compared to preoperative torsion up to 12 months after surgery (P <or=.05). However, there was regression of the torsion effect from 2 months to 12 months after surgery (P =.02). After 12 months, there did not appear to be any further regression at 18 and 24 months postop (P =.79 and.84, respectively), although the number of patients with follow-up beyond 1 year was small (n = 3).


CONCLUSIONS
The Harada-Ito procedure is an effective procedure to treat excyclotorsion. However, regression toward excyclotorsion occurs between 2 months to 12 months postoperatively. These results suggest that an initial overcorrection may aid in long-term success of this procedure.
Nishimura
Julie K
JK
Jules Stein Eye Institute, University of California, Los Angeles, California 90095, USA.
Rosenbaum
Arthur L
AL
D004172:Diplopia / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000503:physiopathology / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures; D012008:Recurrence; D012086:Reoperation; D013536:Suture Techniques; D013710:Tendons / Q000601:surgery