My question is this: is rectus muscle resectioning a fairly bullet proof procedure? What I mean is, is it highly likely to be successful and otherwise unlikely to be unsuccessful in a way that net degradation results to the vision in the affected eye, etc. How about the possibility of the affected muscles re-relaxing to re-create the same lack of alignment? Or is the idea that if you get the alignment close with muscle surgery, and correct the vision enough, that the brain will take over and make the fine adjustments?
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Answered by Richard E. Gans, M. D. (xx102@ofcn.org)
Rectus muscle resections fall into the category of surgery that is used to correct strabismus, or crossed eyes. When two eyes are not aligned properly, the ophthalmologist must determine the cause for the misalignment. Occasionally, the problem can be corrected with glasses or with medication. Most of the time, surgery is necessary.
Most strabismus surgery involves manipulating the muscles, outside the eye, that control eye movement. There are six muscles outside each eye that control eye movement. The muscle can be removed and reattached in a different location on the eye. The muscle can be cut (resected) to shorten it and then reattached to the eye. Usually, a muscle is repositioned to weaken its pulling force. A muscle is shortened to strengthen its pulling force. By balancing the pulling of various muscles on the eye, the eye can be straightened.
Strabismus surgery is usually quite successful in realigning the eyes. The problem that ophthalmologists face is that individuals respond differently to a given amount of surgery. In other words, moving a muscle 5 mm. for one person might have a completely different effect than a 5 mm. operation on someone else. Because of this, a single operation for strabismus has about an 80% success rate in getting the eyes straight. Most eye surgeons warn patients of possible overcorrection or undercorrection from an operation, and the possible need for a second operation to "fine tune" the result. Occasionally, an ophthalmologist will do an operation with an "adjustable suture". This means that the stitches are placed on the eye during surgery, with the patient asleep. Then, after the patient is awake, the stitches are adjusted so that the eye is straight.
The long-term success of an operation for crossed eyes is dependent on several factors. The biggest factor in keeping the eyes aligned is equal vision in both eyes. If one eye sees poorly, it's position will probably drift with time. If both eyes see well, the brain will help to keep them straight. Sometimes, special glasses prescriptions or prisms in glasses are necessary to keep the eyes aligned.
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Copyright, 1994. Richard E. Gans, M.D.
A RICHARD E. GANS, M.D. 11
A A OFCN Primary Sysop, The Eye Clinic 111
AAAAA xx102@ofcn.org 11
A A A C A D E M Y O N E 1111
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NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
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