title: Practical aspects and efficacy of intraoperative adjustment in concomitant horizontal strabismus surgery.
abstract: OBJECTIVE
  To analyze the practical aspects and advantages of one-stage adjustable surgery under topical anesthesia in concomitant horizontal strabismus.
  
  
  METHODS
  A retrospective review of 363 patients was completed to assess (1) the frequency of need to perform adjustment, (2) the amount and pattern of adjustment, and (3) the final alignment at least 6 months after surgery. Intraoperative adjustment was performed strictly toward the aim of orthophoria or slight overcorrection (heterophoria < 6 prism diopters [PD]) while avoiding diplopia.
  
  
  RESULTS
  Of the 363 patients, 261 (72%) required intraoperative adjustment. Of these, 85% of exotropes underwent a decreased amount of surgery compared with the standard amount, whereas 58% of esotropes underwent an increased amount of surgery. Forty-two patients underwent a one-muscle surgery instead of the scheduled two-muscle surgery, and all had less than 35 PD preoperative angle of deviation. Success rates were 83% in all patients with one-stage adjustable sutures and 87% in patients who underwent adjustment. In 42 patients with one-muscle surgery instead of two-muscle surgery, 32 (76%) obtained successful results.
  
  
  CONCLUSIONS
  Intraoperative adjustment was effective in concomitant horizontal strabismus surgery and can provide the opportunity to avoid a large overcorrection, especially in cases with moderate angle horizontal muscle surgery.
authors.affiliation: Institute of Vision Research , Ajou University School of Medicine, Suwon, Korea.
authors.forename: Jeong Ho
authors.initials: JH
authors.lastname: Yi
authors.forename: Seung Ah
authors.initials: SA
authors.lastname: Chung
authors.forename: Yoon Hee
authors.initials: YH
authors.lastname: Chang
authors.forename: Jong Bok
authors.initials: JB
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004172:Diplopia / Q000517:prevention & control; D004948:Esotropia / Q000503:physiopathology / Q000601:surgery*; D005099:Exotropia / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures; D012189:Retrospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome; D015348:Vision, Binocular / Q000502:physiology*; D055815:Young Adult