title: Unilateral lateral rectus resection for horizontal diplopia in adults with divergence insufficiency.
abstract: BACKGROUND
  Divergence insufficiency (DI) is an acquired comitant strabismus in aging individuals, characterized by esotropia and diplopia at distance. Treatment options include occlusion, base-out prism glasses, and a variety of surgical procedures to the horizontal rectus extraocular muscles. Here, we present a large cohort of patients with DI who underwent unilateral resection of the lateral rectus muscle. This is a simple procedure, typically performed under regional anesthesia and on the non-dominant eye.
  
  
  METHODS
  Clinical characteristics and complaints were collected from patients with DI who underwent unilateral lateral rectus resection over a 6.5-year period. Treatment success was evaluated in terms of post-operative symptomatic deviation and the need for prisms in order to achieve sensory fusion.
  
  
  RESULTS
  The cohort consisted of 57 patients (age 54-89 years). The majority sought surgical care after prism glasses were no longer tolerated, or after onset of a larger symptomatic deviation (typically 10 to 18 prism diopters). After surgery (minimum 6 weeks follow-up; median 10 weeks), 86.0 % showed successful results with no further treatment; an additional 10.5 % stayed free of diplopia with a post-operative prism (horizontal or vertical), and only two patients (3.5 %) required further surgery and were considered failures.
  
  
  CONCLUSIONS
  Mild DI is usually treated with a base-out prism. Treatment of pronounced DI with unilateral lateral rectus resection was generally successful, with 96.5 % not requiring further surgery. Unilateral lateral rectus resection appears to be a valid option for treatment of DI.
authors.affiliation: Center for Misaligned Eyes, Dallas, TX, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Stager
authors.forename: Trevor
authors.initials: T
authors.lastname: Black
authors.forename: Joost
authors.initials: J
authors.lastname: Felius
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004172:Diplopia / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures; D012189:Retrospective Studies; D013285:Strabismus / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome; D015348:Vision, Binocular / Q000502:physiology; D014792:Visual Acuity / Q000502:physiology