Analysis of the dosage controversy in recess-resect and Faden surgery with the Robinson computer model of eye movements

Abstract

In recess-resect surgery, the dosage depends on the preoperative angle of squint and on the ratio between squint-angle reduction and dosage that the surgeon has found in previous surgery. Recommendations pertaining to this ratio vary widely among authors. Some say a recession does more than a resection, while others believe the opposite is true. Finally, most find a lower ratio at smaller preoperative angles of squint. We investigated the matter, using our modified version of the Robinson computer model of eye movements. We calculated the amounts of surgery needed to reduce 10, 15, 20, 25, and 30 degree angles of squint to zero. The increase of the ratio at large angles of squint was indeed predicted by the model. The decrease at small angles of squint, however, was not predicted by the model. We found it impossible to model the decrease of the ratio at small preoperative angles of squint. The ratios for recess and resect surgery were approximately similar. We present an inventory of the possible causes of the discrepancies. In addition, we calculated the effects of Faden surgery and found that the predictions of the computer model correspond closely to reality.

Surgical Management

“…Placing the PFS more anteriorly reduces the effectiveness of the procedure; placing the suture more posterior than recommended results in greater variability (Simonsz and van Dijk 1987). If the eye is rotated away from the operation site the muscle will be pulled forwards so that the sutures pass from their scleral insertion through the muscle more anteriorly.…”