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Lyle During the total period of follow-up, none of the patients developed an alternative neurologic disorder. Tranaglyphs are similar to vectograms, however instead of there being two different transparent image cards that need to be fused into one, there is one image card with a stereo image already pre-made onto the card. It is also stated that primary divergence insufficiency does not possess any other neurological symptoms as well as signs. This page has been accessed 63,795 times. A 5-year-old female initially presented for a strabismus and amblyopia evaluation. Eight (40%) of the 20 patients recalled such an event, including a viral prodrome in 3 patients, minor head trauma in 2 patients, and hospitalization for an unrelated illness in 3 patients. Her cover test revealed a 25 PD constant right esotropia with a 2 PD constant right hypotropia. They concluded that medial rectus recession is as effective as lateral rectus resection and suggested that double the distance angle of esotropia should be used as the surgical target. Vision therapy uses various exercises to train the connection between the eyes and the brain as more than 50% of the brain is dedicated to visual function. A 25-year-old female presented complaining of double vision and headaches that worsened with prolonged near work. It is possible that with longer follow-up, the number of patients with resolution of diplopia might increase. The global layer of each rectus EOM, passes through the pulley and becomes contiguous with the tendon to insert on the globe. published a case series of long-term follow up for 29 patients with divergence insufficiency esotropia underwent lateral rectus resection. JAInman 2008;126(10):1336-49. The LR-SR band vertically supports the LR pulley against the downward force of the inferior oblique muscle to maintain the LR pulleys vertical position. reported a series of 57 patients underwent unilateral lateral rectus resection for distance esotropia deviations of 530 with 96.5% did not require further surgery.[11]. To increase convergence, the two cards will be pushed inward, making the image smaller (Small In for the SI in SILO). In some circumstances, individuals with divergence insufficiency will also suffer from high esophoria or. Patients and methods. Br J Ophthalmol. Define divergence insufficiency. Individuals with convergence insufficiency often have a low AC/A ratio and a low near point of convergence. 2005;89(10):1318-23. Chaudhuri Z, Demer JL. MThe child with divergence paresis. 132. Unilateral lateral rectus resection for horizontal diplopia in adults with divergence insufficiency. Convergence insufficiency is an anomaly that causes the eye to under-converge at near. RDInternuclear ophthalmoplegia in giant cell arteritis. If hypertropia persisted, further 5%10% increments of GVRT up to a maximum of 90% were added with monitoring of alignment. 2005;9:711. What causes divergence insufficiency? Also found significant displacement of all four rectus pulleys away from the orbital center, lateral displacement of the inferior rectus pulley and obliquely angulated lateral rectus pulley. There were 20 patients classified as having primary and 15 patients classified as having secondary divergence insufficiency. Retrospective survey of patients with divergence insufficiency. In this example, the patient will be asked to either relax his or her eyes to put the lion in the cage (diverge) or stimulate his or her eyes to put the lion in the cage (converge). Patients with sagging eye syndrome can be treated surgically if they do not respond to or do not desire prism therapy.