{
  "abstract": "Modified Harada-Ito surgery is traditionally used to treat excyclotorsion due to superior oblique weakness. However, it may also be utilised for restrictive torsional diplopia. We present a large case series of outcomes following Harada-Ito surgery.73 modified Harada-Ito operations were identified at a tertiary hospital; 56 for IV nerve palsy, 8 for restrictive and 9 for other non-restrictive causes. 11 Consultants performed the operations (range 1–21), which were classified as full or partial, depending on whether the tendon was fully advanced to the superior lateral rectus border. Unilateral full surgery provided a mean improvement of 6° incyclotorsion in primary position, and 7.75° in worst gaze position. This represents improvements of 0.46° and 0.54° per mm of advancement. Partial surgery provided 5.68° and 6.53° of total improvement respectively. These were similar among the different groups, however restrictive causes appeared to regress more rapidly. 35 patients (47.9%) had resolution of diplopia in at least primary position, although most had persistent diplopia in extreme gaze. No patients with restrictive strabismus had resolution of diplopia after Harada-Ito alone. 7 patients (9.6%) developed iatrogenic Brown syndrome, while 1 developed scarring requiring surgical release. 24 patients (32.9%) had subsequent surgery for ongoing diplopia.Modified Harada-Ito surgery is an effective treatment for torsional diplopia. This is the largest outcome study to date and suggests more modest improvements than some previous studies. The surgical effect may be more transient in restrictive cases. Serious complications are rare, but further surgery is common, particularly where horizontal or vertical diplopia co-exists.",
  "authors": [
    {
      "affiliations": [
        "Moorfields Eye Hospital, London, UK"
      ],
      "name": "James Miller"
    },
    {
      "affiliations": [
        "Moorfields Eye Hospital, London, UK"
      ],
      "name": "Joanne Hancox"
    },
    {
      "affiliations": [
        "Moorfields Eye Hospital, London, UK"
      ],
      "name": "Alasdair Kennedy"
    }
  ],
  "title": "130322 Outcomes of modified Harada-Ito surgery for paretic and restrictive torsional diplopia at a tertiary eye hospital",
  "uid": "8e589548-207e-5ebb-ae10-ab48e3c5528b"
}