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Harada-Ito procedure

The Harada-Ito procedure is a superior oblique tendon operation for excyclotropia in patients with paresis of the superior oblique muscle.1 The surgeon displaces the anterior portion of the superior oblique tendon anteriorly and laterally, which increases the incycloduction effect of the muscle.1

The anterior fibers of the superior oblique tendon are mainly responsible for intorsion and the posterior fibers for depression, so the two actions can be manipulated separately.2 In the original operation, a nonabsorbable 5-0 suture is passed through the anterior portion of the tendon 3 mm nasal to its insertion.1 The suture is then passed through superficial sclera 3 mm temporal and anterior to the insertion, and tying it pulls the anterior portion of the tendon laterally and anteriorly.1

More detail

Fells modified the operation by splitting the tendon at its insertion and transposing the anterior half anteriorly and laterally, and an adjustable suture has also been advocated.1 The effect of the operation tends to diminish over time, so a slight overcorrection on the first postoperative day should not be reversed by suture adjustment.1 In a series of nine patients, the procedure reduced excyclotropia by 8° to 25° in primary position and by 12° to 30° in downward gaze.1

Sources (22)
  1. von Noorden and Campos, Binocular Vision and Ocular Motility, ch. 26
  2. Kanski, Clinical Ophthalmology (2024), ch. 18
  3. Agarwal, S. (2020). Strabismus Surgery. In: Agarwal, S. (ed.) Strabismus Simplified. Springer, Singapore. https://doi.org/10.1007/978-981-15-2135-0_9
  4. American Academy of Ophthalmology (2020). Harada-Ito Procedure. [online] Available at: https://www.aao.org/bcscsnippetdetail.aspx?id=6774bb15-13b5-45a5-b00e-281de94787bb [Accessed 8 May 2024].
  5. Bradfield, Y.S., Struck, M.C., Kushner, B.J., Galal, A., Drummond, G.T. and Keech, R.V. (2012). Surgical treatment of acquired superior oblique palsy. Journal of American Association for Pediatric Ophthalmology and Strabismus, 16(5), pp.460-463.
  6. Kushner, B.J. (2017). Strabismus. In: Olitsky, S.E. (ed.) Pediatric Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-319-28315-5_10
  7. Rutstein, R. and Daum, K. (1997). Anomalies of Binocular Vision: Diagnosis & Management. St. Louis: Mosby.
  8. The Harada-Ito Procedure - Eyetube
  9. Surgical Outcomes of Nonadjustable Modified Harada-Ito Surgery
  10. Clinical Features and Surgical Results in Harada-Ito Surgery Patients
  11. Harada-Ito Procedure - American Academy of Ophthalmology
  12. The Adjustable Harada-Ito Procedure JAMA Ophthalmology
  13. Modified Harada-Ito Procedure in Acquired Superior Oblique Palsy ...
  14. Color Atlas of Strabismus Surgery
  15. The diagnosis and surgical management of acquired ... - Nature
  16. Effect of the Harada–Ito Procedure on Dynamic Eye Movements in ...
  17. The long-term torsion effect of the adjustable Harada-Ito procedure
  18. Full article: Surgical outcome of graded Harada-Ito procedure in the ...
  19. Harada-Ito eye operation · 3millionsteps
  20. Full article: Outcomes of the Harada–Ito Procedure
  21. Principles of Strabismus Surgery for Common Horizontal and ... secondary
  22. Harada Ito Procedure - EyeRounds

Reviewed October 2026

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