Adherence syndrome following inferior oblique surgery: management and outcome of 14 cases.
BACKGROUND
Adherence Syndrome is diagnosed by limited upgaze, usually in the presence of an ipsilateral consecutive hypotropia in primary position, which is worse in lateral gaze. There is also a positive forced duction test.


METHODS
A retrospective review of patients diagnosed with sdherence syndrome following strabismus surgery under the care of a single ophthalmologist between 1989 and 2001 was performed. Fourteen patients were identified. All patients were thought to have undergone previous ipsilateral inferior oblique surgery, which was felt to be the cause of the restriction.


RESULTS
We usually performed an extensive conjunctival peritomy over nearly 180 degrees, recessing the conjunctiva while leaving the sclera to re-epithelialise, and in addition recessed the inferior rectus by 2.5-3 mm. Only one patient required an additional operation. Of the 11 patients who had undergone surgery at our institution all showed a significant improvement in their symptoms. five were discharged happy, three continue to be followed and three failed to attend further appointments after their initial visit two weeks post-operation.


CONCLUSIONS
It is not possible to restore normal eye movements in these patients. Our results show that one can improve the appearance in primary position with single vision. Patients should be given realistic expectations before surgery and the limited aims of surgery must be explained.
Burton
Ben
B
Department of Strabismus and Paediatrics, Moorfields Eye Hospital, London, UK.
Dawson
Emma
E
Lee
John
J
D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D015835:Ocular Motility Disorders / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D009801:Oculomotor Muscles / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D013285:Strabismus / Q000601:surgery*; D013536:Suture Techniques; D013577:Syndrome; D016896:Treatment Outcome