Harada–Ito procedure

Harada–Ito procedure is a surgical technique used in the treatment of specific types of strabismus, particularly torsional or cyclotorsional strabismus, where there is an abnormal rotation of the eye around the visual axis. This procedure is named after the surgeons who developed it, Mitsuo Harada and Kenneth Ito. It specifically addresses the correction of torsional diplopia by adjusting the position of the superior oblique muscle, one of the extraocular muscles responsible for eye movement.

Indications

The Harada–Ito procedure is primarily indicated for patients with trochlear nerve palsy or those who have a congenital or acquired superior oblique muscle weakness, leading to torsional diplopia (double vision). It is also indicated in cases where there is a significant excyclotorsion of the eye, which cannot be corrected by standard strabismus surgeries.

Surgical Technique

The procedure involves the anterior fibers of the superior oblique tendon being isolated and advanced towards the lateral rectus muscle. This adjustment aims to increase the tendon's effect on intorsion, thereby correcting the torsional misalignment without significantly affecting the vertical or horizontal eye movements. The surgery is typically performed under general anesthesia and can be done on an outpatient basis.

Outcomes

Patients undergoing the Harada–Ito procedure often experience significant improvement in their torsional diplopia and overall binocular vision. The success of the surgery depends on accurate diagnosis, precise surgical technique, and the underlying cause of the torsional strabismus. Postoperative care includes eye patching, use of corrective lenses, and sometimes additional strabismus surgeries to fine-tune eye alignment.

Complications

As with any surgical procedure, the Harada–Ito procedure carries risks of complications, including infection, overcorrection or undercorrection of the torsional deviation, and other standard risks associated with anesthesia. However, serious complications are rare, and the procedure is generally considered safe and effective for the appropriate candidates.

Conclusion

The Harada–Ito procedure represents a significant advancement in the surgical management of torsional strabismus, offering hope for patients with conditions that were previously difficult to treat. Its development underscores the importance of specialized surgical techniques in the field of ophthalmology and strabismus management.