Harada-Ito procedure
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The Harada-Ito procedure is an eye muscle operation designed to improve the excyclotorsion experienced by some patients with cranial nerve IV palsy. In this procedure, the superior oblique tendon is split, and the anterior fibers -- the fibers most responsible for incyclotorsion -- are moved anteriorly and laterally. This selectively stretches and tightens these fibers, enhancing the incyclotorsion power of the superior oblique.
The most common indication for the Harada-Ito procedure is bilateral acquired cranial nerve IV palsy following closed head trauma (particularly automobile accidents). In this clinical situation the vertical imbalance is often less symptomatically bothersome to the patient than the induced excyclotorsion. Affected patients have a particularly annoying type of double vision (diplopia), wherein the images are twisted (excyclotorted).
Patients with cranial nerve IV palsy whose complaints are not specifically limited to torsional diplopia, but instead also have significant vertical diplopia, are not good candidates for a Harada-Ito procedure. Instead, a recession of the inferior oblique muscle, or another strabismus operation may be indicated.
References
- Metz H, Lerner H: The adjustable Harada-Ito procedure. Arch Ophthalmol 1981;99 [1].
- Nishimura JK, Rosenbaum AL (2002). "The long-term torsion effect of the adjustable Harada-Ito procedure". J AAPOS 6 (3): 141–4. PMID 12075289.
See also
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
