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Purpose : To describe the clinical and radiological characteristics of Indonesian patients with HES, and their surgical outcomes.
Methods : Retrospective chart review of patients with HES at Kirana Cipto Mangunkusumo Hospital, Jakarta.
Results : Of 17 subjects (27 eyes), 94.1% were over 40 yo, having a mean age at admission of 51.25±0.45 yo, and 70.6% were women. Mean duration of strabismus was 4.5 years and 52.9% were bilateral. The mean refraction was -17.45 diopters with 1 case of moderate myopia, and 1.78 logMar of mean BCVA. Esodeviation measurement was 90.67±7.53∆, and abduction and elevation were limited with a median of -4 (-5 – 0), and all cases yielded positive forced duction tests intraoperatively. Age was shown to have a clinical relationship towards laterality and size of deviation. The mean axial length of subjects was 29.76 (21.56-32.60) mm, and all had superotemporal herniation of the globe, displacements of both the superior rectus lateral rectus with a median angle of displacement of 160.48º (93.46º-178.71º). Angles of displacment between recti showed a significant correlation with axial length (p=0.035), with the size of esotropia clinically, however not with the status of refraction (p = 0.84). Surgery was performed on all patients through a Yokoyama (loop myopexy) procedure with medial rectus recession, with or without anchorage of the uniting suture to the sclera, yielding more satisfactory results with supramaximal recession and anchorage.
Conclusion : Indonesian patients admit themselves at a relativley earlier age but with higher bilaterality and larger deviations than previously reported. In order to prevent patients from being managed at an advanced stage, radioimaging should be performed for all patients experiencing progressive estotropia with moderate-high myopia. In HES cases with positive forced duction tests, Yokoyama procedure with supramaximal recession of the medial rectus plus anchorage of the uniting suture to the sclera is preferrably recommended.
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