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Oke I, Lorenz B, Basiakos S, Gokyigit B, Dodd MMU, Laurent E, Sadiq MA, Goberville M, Elkamshoushy A, Tsai CB, Gravier N, Speeg-Schatz C, Shepherd JB, Saxena R, Soni A, Hunter DG, Shah AS, Dagi LR. Extraocular muscle ductions following nasal transposition of the split lateral rectus muscle. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023; 58:565-569. [PMID: 36372135 DOI: 10.1016/j.jcjo.2022.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 10/22/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To quantify changes in ductions following nasal transposition of the split lateral rectus muscle (NTSLR) for treating third nerve palsy. DESIGN Retrospective cohort study. PARTICIPANTS A single eye from each patient with third nerve palsy treated with NTSLR with ocular motility measurements. METHODS Observation of changes in pre- and postoperative ductions. Outcome measures including patient demographic and surgical factors associated with the ability to adduct beyond the midline after NTSLR were evaluated using multivariable logistic regression. RESULTS A total of 116 patients met the inclusion criteria for this study. The NTSLR significantly decreased abduction (median of 0 limitation [interquartile range (IQR), 0-0] prior to surgery to -4 [IQR, -4 to -3] after NTSLR; p < 0.001), with a corresponding improvement in adduction (median, -5 [IQR, -5 to -4] prior to surgery to -4 [IQR, -4 to -3] after NTSLR; p < 0.001). There was no change in median supraduction or infraduction after NTSLR (p > 0.05). The ability to adduct beyond the midline after NTSLR was demonstrated in 42% of patients. Although not statistically significant, a trend toward a postoperative ability to adduct beyond the midline was seen in patients who had concurrent superior oblique muscle tenotomy (odds ratio [OR] = 5.08; 95% CI, 0.91-40.9) or who were designated with partial rather than complete third nerve palsy (OR = 2.29; 95% CI, 0.82-6.70). CONCLUSIONS NTSLR improves the horizontal midline positioning of eyes with third nerve palsy. Most eyes lose the ability to abduct, but some regain a modest ability to adduct while vertical ductions remain unchanged.
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Affiliation(s)
- Isdin Oke
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Birgit Lorenz
- Department of Ophthalmology, Justus Liebig University Giessen, Universitaetsklinikum Giessen and Marburg GmbH, Giessen Campus, Giessen, Germany
| | - Sotirios Basiakos
- Department of Ophthalmology, Justus Liebig University Giessen, Universitaetsklinikum Giessen and Marburg GmbH, Giessen Campus, Giessen, Germany
| | - Birsen Gokyigit
- Pediatric Ophthalmology and Strabismus Department, Prof. Dr. N. Reşat Belger Beyoglu Education and Research Eye Hospital, Istanbul, Turkey
| | - Mary-Magdalene Ugo Dodd
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Erick Laurent
- Centre d'Ophtalmologie du Lez et Clinique St. Jean, Montpellier, France
| | - Mohammad Ali Sadiq
- Institute of Ophthalmology, King Edward Medical University, Mayo Hospital, Lahore, Pakistan
| | | | - Amr Elkamshoushy
- Department of Ophthalmology, University of Alexandria, Alexandria, Egypt
| | - Chong-Bin Tsai
- Department of Ophthalmology, Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Nicholas Gravier
- Unité de Strabologie-Polyclinique de l'Atlantique, Nantes-Saint-Herblain Cedex, France
| | | | | | - Rohit Saxena
- Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | | | - David G Hunter
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Ankoor S Shah
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Linda R Dagi
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, MA.
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Yahalom C, Hunter DG, Dagi LR. Strategies for managing strabismus from oculomotor nerve palsy. J AAPOS 2023; 27:3-9. [PMID: 36640897 DOI: 10.1016/j.jaapos.2022.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/25/2022] [Accepted: 11/02/2022] [Indexed: 01/13/2023]
Abstract
Addressing ocular misalignment secondary to partial and complete oculomotor nerve palsy presents a special challenge to the strabismus surgeon, particularly when treating patients with binocular diplopia. We review the reported surgical options and, through illustrative cases, provide our own perspective on managing this disorder.
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Affiliation(s)
- Claudia Yahalom
- Department of Ophthalmology, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - David G Hunter
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Linda R Dagi
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
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Zhang X, Cui H, Liu Y, Zhang L, Du R, Yuan H, Achakzai R, Zheng S. Acupuncture for oculomotor nerve palsy:A systematic review and meta-analysis. Complement Ther Med 2022; 71:102888. [PMID: 36152935 DOI: 10.1016/j.ctim.2022.102888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND To evaluate the safety and efficacy of acupuncture in the treatment of oculomotor nerve palsy (ONP). METHODS The following database will be required from PubMed, Cochrane Library, Medline, Chinese Biomedical Literature Database, China National Knowledge Infrastructure (CNKI), Wanfang data. Randomized controlled trials (RCTs) comparing acupuncture alone versus no treatment/another active therapy/sham acupuncture or comparing acupuncture with another active therapy versus the same active therapy were included. Meta-analysis was conducted according to the 2020 PRISMA guidelines. Data was analyzed using RevMan 5.4 software. Results were reported as risk ratios (RR) for dichotomous outcomes or mean differences (MD) for continuous outcomes, with 95 % confidence intervals (CI). The Cochrane risk of bias tool was used to access the methodological quality of the trails. RESULTS Eighteen RCTs with 1150 participants comparing acupuncture versus other therapies were included. The results showed a significant differences in the clinical efficiency rate (RR = 1.30, 95 %CI = 1.23-1.37, P < 0.001), scores of diplopia (MD = - 0.78, 95 %CI = - 1.39 to - 0.77, P < 0.001), palpebral fissure size (MD = 1.04, 95 %CI = 0.41-1.68, P = 0.001), the pupil diameter (MD = - 0.56, 95 %CI = - 0.70 to - 0.42, P < 0.001), quality of life (MD = 8.96, 95 %CI = 6.79-11.13, P < 0.001) between the experiment and control groups. However, there were no significant differences in the adverse effects (RR = 0.52, 95 %CI = 0.22-1.22, P = 0.13). The quality of the evidence test by GRADE was low or very low. CONCLUSION Most included studies suggested that acupuncture was more effective than the control group in the treatment of ONP. However, the quality evidence of most of the studies was low and most of them were performed in China.
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Affiliation(s)
- Xiaohui Zhang
- School of Traditional Chinese Medicine, Capital Medical University, Beijing 100069, China
| | - Hai Cui
- School of Traditional Chinese Medicine, Capital Medical University, Beijing 100069, China
| | - Yijiang Liu
- School of Traditional Chinese Medicine, Capital Medical University, Beijing 100069, China
| | - Lu Zhang
- School of Traditional Chinese Medicine, Capital Medical University, Beijing 100069, China
| | - Ruosang Du
- School of Traditional Chinese Medicine, Capital Medical University, Beijing 100069, China
| | - Hongwen Yuan
- School of Traditional Chinese Medicine, Capital Medical University, Beijing 100069, China
| | - Rehmatullah Achakzai
- Balochistan Institute of Psychiatry & Behavioral Sciences, Bolan Medical College Hospital, Pakistan
| | - Shumei Zheng
- School of Traditional Chinese Medicine, Capital Medical University, Beijing 100069, China.
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Elabbasy M, Naxer S, Horn M, Schittkowski MP. The use of lyophilized bovine pericardium (Tutopatch®) in the management of third nerve palsy following prior conventional strabismus surgery - a case series. Strabismus 2022; 30:171-182. [PMID: 36178167 DOI: 10.1080/09273972.2022.2123943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
To study the secondary management of strabismus due to third nerve palsy using bovine pericardium (Tutopatch®) when previous conventional surgical therapy had failed. Review of our clinic records of selected patients with third nerve palsy, in whom residual deviation had been managed using Tutopatch® after previous surgical correction. The squint angle was measured preoperatively, and at 1 day, 3 months, and if possible 6 months postoperatively. Nine patients were enrolled in this study. One patient had mainly residual vertical deviation and was corrected with tendon elongation of the contralateral superior rectus. Three patients were operated on with tendon elongation of the lateral rectus muscle with or without medial rectus muscle resection and/or advancement (Group 1). Lateral rectus splitting after tendon elongation in addition to the resection and/or advancement of the medial rectus was performed in five patients with complete third nerve palsy (Group 2). In Group 1, the preoperative median squint angle was -20° (range -17° to -25°), which improved postoperatively to -4.5° (range -12° to +3°). In Group 2, the preoperative horizontal and vertical median squint angles were -27° (range -20° to -40°) and 0.5° (range 0° and 20°), respectively. Postoperatively, they had improved to -12.5° (range-2° to -25°), and 1.5° (range 0° to 7°), respectively. Two patients of Group 2 were re-operated due to residual exotropia. No postoperative complications were observed in any patient. In this small series several complex re-do situations of patients with third nerve palsy were evaluated in which Tutopatch® markedly improved outcomes after an initially ineffective surgical management. For better evaluation of its usefulness a study with more patients is recommended.
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Affiliation(s)
- Mohamed Elabbasy
- Department of Ophthalmology, Section of Strabismus, Neuroophthalmology and Oculoplastic Surgery, University Medical Center of Goettingen, Goettingen
| | - Sabine Naxer
- Department of Ophthalmology, Section of Strabismus, Neuroophthalmology and Oculoplastic Surgery, University Medical Center of Goettingen, Goettingen
| | - Maren Horn
- Department of Ophthalmology, Section of Strabismus, Neuroophthalmology and Oculoplastic Surgery, University Medical Center of Goettingen, Goettingen
| | - Michael P Schittkowski
- Department of Ophthalmology, Section of Strabismus, Neuroophthalmology and Oculoplastic Surgery, University Medical Center of Goettingen, Goettingen
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Hull S, Al-Hayouti H, Verity DH, Rose GE, Adams GGW. Periosteal fixation of the medial and lateral recti for large-angle incomitant exotropia. Graefes Arch Clin Exp Ophthalmol 2022; 260:2347-2351. [PMID: 35122499 DOI: 10.1007/s00417-022-05567-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 01/07/2022] [Accepted: 01/14/2022] [Indexed: 01/15/2023] Open
Abstract
PURPOSE To describe the evolution of a surgical technique for the correction of large-angle incomitant exodeviations. METHODS Retrospective review of an interventional case series from 2005 to 2019 in a single centre, with analysis of surgical procedure, prism diopter (PD) deviations and complications. RESULTS Thirty-one patients underwent surgery at an average age of 42 years (range 4-75 years) for minimal medial rectus function, mostly from oculomotor nerve palsy (23/31; 74%). The mean pre-operative exodeviation was 75 PD (range 30-200PD). Sixteen patients (52%) had undergone previous strabismus surgery. Thirty-eight operations were performed in which the medial rectus insertion was anchored to the periosteum of the posterior lacrimal crest via a retrocaruncular transconjunctival approach. The ipsilateral lateral rectus (LR) was disinserted and fixed to lateral orbital tissue in 29/38 (76%) operations, injected with botulinum toxin in 5, recessed in 2 and had already undergone maximal LR recession in 2. In all but the first 8 operations, temporary limbal sutures were passed through the eyelids to maximally adduct the globe post-operatively. At last follow-up (mean 24 months; range 2-130), the mean reduction in exodeviation was 49PD (range 10-80) and overall residual deviation was 26PD (range 80PD base-in to 14PD base-out). The 5 LR toxin procedures had a mean reduction of 22PD (range 10-40). Seven patients had persistent diplopia, one a transient corneal erosion and one caruncle suture exposure 4 years after surgery. CONCLUSION Large-angle exodeviations can be markedly improved by bi-rectus fixation. This approach is both safe and effective and can be performed in complex patients with multiple previous procedures.
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Affiliation(s)
- Sarah Hull
- Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK. .,UCL Institute of Ophthalmology, London, UK.
| | - Huda Al-Hayouti
- Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK
| | - David H Verity
- Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK.,UCL Institute of Ophthalmology, London, UK
| | - Geoffrey E Rose
- Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK.,UCL Institute of Ophthalmology, London, UK
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Nasal Transposition of the Split Lateral Rectus Muscle for Strabismus Associated with Bilateral 3 rd-Nerve Palsy. Am J Ophthalmol 2022; 242:165-172. [PMID: 35750218 DOI: 10.1016/j.ajo.2022.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/08/2022] [Accepted: 06/13/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE To determine success rate and complications associated with nasal transposition of the split lateral rectus muscle (NTSLR) for treating bilateral 3rd-nerve palsy. DESIGN Retrospective, interventional case series METHODS: : Setting: International, multicenter registry Study population: All patients with bilateral 3rd-nerve palsy treated with NTSLR. OBSERVATION Sensorimotor evaluations before and 6-months after unilateral or bilateral NTSLR. OUTCOME MEASURES Post-operative horizontal alignment ≤ 15 prism diopters (PD), intraoperative technical difficulties, and vision-threatening complications. The association of patient demographics and surgical technique with each outcome was analyzed using multivariable logistic regression. RESULTS Thirty-four patients were included with a median age of 46 years (Interquartile range [IQR], 25-54 years) at surgery. The most common etiologies were ischemic (29%), neoplastic (15%), and congenital (12%). NTSLR performed unilaterally with alternative surgery on the opposite eye (65%) resulted in a median post-operative exotropia of 18 PD (IQR, 7-35 PD), and when performed bilaterally (35%) resulted in post-operative exotropia of 14 PD (IQR, 5-35 PD). Success was achieved in 50% of cases, intra-operative technical difficulties reported in 18%, and vision-threatening complications occurred in 21%. Attachment of the lateral rectus muscle ≥ 10 mm posterior to the medial rectus insertion was associated with increased vision-threatening complications (OR, 9.0; 95% CI, 1.3-99). CONCLUSIONS NTSLR can address the large-angle exotropia associated with bilateral 3rd-nerve palsy. Surgeons should be aware that posterior placement of the lateral rectus muscle can increase the risk of vision-threatening complications, particularly serous choroidal effusion.
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7
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Wen Y, Shen T, Yan J. Larger Than Larger: Huge Amounts of Recession-Resection Surgery for Third Nerve Palsy. J Pediatr Ophthalmol Strabismus 2022; 60:184-194. [PMID: 35758195 DOI: 10.3928/01913913-20220428-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe the characteristics and management outcomes of strabismus surgery in patients with third cranial nerve palsy and identify factors associated with long-term outcomes. METHODS A 10-year retrospective study of patients with third cranial nerve palsy who underwent strabismus surgery was performed at Zhongshan Ophthalmic Center, Sun Yat-sen University, China, between August 2010 and January 2021. Clinical characteristics and factors associated with long-term outcomes were evaluated. Success of surgery was defined as esotropia of 15 prism diopters (PD) or less at postoperative day 1 (POD1) or any deviation of 10 PD or less at postoperative month 2 (POM2) or later. RESULTS A total of 91 patients were included, with a mean age of 24.02 ± 15.38 years (range: 2 to 64 years). Forty-one patients (45.1%) were diagnosed as having complete palsy. Congenital palsy accounted for 40.7% (n = 37). Mean follow-up time was 2.50 ± 1.78 years (range: 8 months to 8 years). One-step surgery was performed in 78.0% of cases (n = 71), a staging procedure in 7.7% (n = 7), and reoperations in 14.3% (n = 13). Most patients had supra-maximal recession and resection of the horizontal rectus muscle with additional techniques, including horizontal rectus transposition, superior oblique transposition, traction sutures, and fixation of the globe. The mean surgical dosage performed on the horizontal rectus muscle was 18.52 ± 5.69 mm (range: 8 to 35 mm). Success rates at postoperative month 8 (POM8) were 69.0% (49 of 71) in the one-step surgery group, 57.1% (4 of 7) in the staging surgery group, and 46.2% (6 of 13) in the reoperation group. Preoperative horizontal deviation (odds ratio [OR]: 1.07, 95% CI: 1.02 to 1.13, P = .011), horizontal deviation at POD1 (OR: 0.86, 95% CI: 0.76 to 0.97, P = .016), and horizontal deviation at POM2 (OR: 1.53, 95% CI: 1.18 to 1.98, P = .001) were associated with the outcomes at POM8. Patients with partial palsy had a higher success rate than those with complete palsy (76.0% vs 51.2%, P = .014). CONCLUSIONS Supra-maximal recession and resection with additional techniques yields satisfying surgical results in patients with third nerve palsy when a larger surgical dose is performed for an initial overcorrection for 15 to 25 PD at POD1. The cases with complete palsy showing a larger deviation were prone to failure. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XX-XX.].
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Artificial Intelligence Segmentation Algorithm-Based Optical Coherence Tomography Image in Evaluation of Binocular Retinopathy. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:3235504. [PMID: 35693270 PMCID: PMC9177319 DOI: 10.1155/2022/3235504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 11/25/2022]
Abstract
On account of optical coherence tomography (OCT) images with intelligent segmentation algorithm, this article investigated the clinical efficacy and safety of docetaxel combined with fluorouracil. In this study, 60 patients with retinopathy treated in hospital were selected as the research objects. There were 30 cases in each group, the control group was treated with conventional images, and the observation group was treated with algorithm-based OCT images. Intelligent segmentation boundary detection algorithm, boundary tracking, and contour localization were proposed and applied to the OCT images of patients to analyze features and measure corneal thickness in OCT images with high signal-to-noise ratio and noise and artifacts. Objects in the control group were treated with semiconductor laser, and those in the observation group were treated with OCT images with algorithm in addition to the treatment of the control group. The results showed that the number of images with relative error of 2 was more, and the number of images with relative error of -2 was the least. The average thickness of high-quality images was 562.7 μm, and the average thickness of images with noise and artifacts was 573.8 μm. The total effective rate of the observation group was 96.67%, which was significantly higher than that of the control group (80%), and the curative effect and physical improvement rate of the observation group were significantly better than that of the control group (P < 0.05). All in all, the feature extraction of OCT images and corneal measurement proposed in this study had a good measurement effect, and the method had the advantages of strong anti-interference ability and high measurement accuracy.
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Shah AS, Dodd MMU, Gokyigit B, Lorenz B, Laurent E, Sadiq MAA, Tsai CB, Gravier N, Goberville M, Basiakos S, Zurakowski D, Dagi LR. Worldwide outcomes of nasal transposition of the split lateral rectus muscle for strabismus associated with 3rd-nerve palsy. Br J Ophthalmol 2021; 107:725-731. [PMID: 34880051 PMCID: PMC10176407 DOI: 10.1136/bjophthalmol-2021-319667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 11/13/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS To determine success rate and complications associated with nasal transposition of the split lateral rectus muscle (NTSLR) for treating strabismus from 3rd-nerve palsy. METHODS An international, multicentre, registry of patients with unilateral 3rd-nerve palsy treated with NTSLR was created. Patients with concurrent surgery on the contralateral eye were excluded. Primary outcome was horizontal alignment within 15 prism dioptres (PD) of orthotropia. Incidence of technical difficulties and vision-threatening complications by 6 months post-procedure were reported. RESULTS Ninety-eight patients met inclusion criteria. Median age was 33.5 years (IQR 10.75-46). Aetiologies included congenital (31%), neoplastic (16%) and traumatic (15%). Twenty-five per cent of patients had prior ipsilateral strabismus surgery. Median exotropia decreased from 70PD preoperatively (IQR 50-90) to 1PD postoperatively (IQR 0-15.5), with a success rate of 69%. Performing concurrent superior oblique muscle tenotomy (SOT) was independently associated with success (p=0.001). Technical challenges occurred in 30% of cases, independently associated with a history of ipsilateral strabismus surgery (p=0.01). Eleven per cent of patients had vision-threatening complications, independently associated with more posterior placement of the split lateral rectus (LR) muscle (p<0.001), and most commonly transient serous choroidal effusion. Surgical placement of the split LR muscle within 4.25 mm of the medial rectus (MR) muscle insertion reduced this risk. CONCLUSION NTSLR significantly improved primary position alignment altered by 3rd-nerve palsy. Concurrent SOT and placement of the split LR muscle ≤4.25 mm posterior to the MR muscle insertion optimised outcomes. NTSLR proved technically challenging when prior ipsilateral strabismus surgery had been performed.
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Affiliation(s)
- Ankoor S Shah
- Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, USA.,Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Mary-Magdalene Ugo Dodd
- Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, USA.,Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Birsen Gokyigit
- Pediatric Ophthalmology and Strabismus, Prof Dr N Reşat Belger Beyoglu Education and Research Eye Hospital, Istanbul, Turkey
| | - Birgit Lorenz
- Ophthalmology, Justus-Liebig-University, Universitätsklinikum Gießen und Marburg GmbH, Gießen, Germany
| | - Erick Laurent
- Centre d'Ophtalmologie du Lez, Clinique St Jean, Montpellier, France
| | - Mohammad Ali Ayaz Sadiq
- Institute of Ophthalmology, King Edward Medical University, Lahore, Pakistan.,Institute of Ophthalmology, Mayo Hospital Lahore, Lahore, Pakistan
| | - Chong-Bin Tsai
- Ophthalmology, Chiayi Christian Hospital, Chia-Yi, Taiwan
| | - Nicolas Gravier
- Unité de Strabologie-Polyclinique de l'Atlantique, Nantes-Saint-Herblain Cedex, France
| | | | - Sotirios Basiakos
- Ophthalmology, Justus Liebig Universitat Giessen, Giessen, Germany.,Thessaloniki, Central Macedonia, Greece
| | - David Zurakowski
- Anesthesia, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Linda R Dagi
- Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, USA .,Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
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Wabbels B, Fricke J, Schittkowski M, Gräf M, Lorenz B, Bau V, Nentwich MM, Atili A, Eckstein A, Sturm V, Beisse C, Sterker I, Neppert B, Mauschitz MM. Yokoyama procedure for esotropia associated with high myopia: real-world data from a large-scale multicentre analysis. Acta Ophthalmol 2021; 99:e1340-e1347. [PMID: 33655633 DOI: 10.1111/aos.14808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 01/26/2021] [Accepted: 02/02/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE High myopic patients may develop strabismus due to globe dislocation out of the normal extraocular muscle cone. Surgical correction of this strabismus type is possible by joining the superior and lateral rectus muscles without the need for a scleral suture called the Yokoyama procedure. Data from large patient samples and the evaluation of a potential effect of an additional medial rectus recession (MRR) have been lacking so far. METHODS We pooled retrospective patient data of 14 departments of ophthalmology in Germany and Switzerland and analysed determinants of postoperative results using multivariable regression models. RESULTS We included 133 patients (mean age: 59.7 ± 13.4 years, surgery between 2008 and 2017) with a mean preoperative esotropia (both Yokoyama with and without MRR) of 23.8°±4.6°. The angle of preoperative esotropia increased with age. The postoperative esotropia was 8.7° ± 9.9°, and six patients were overcorrected. While preoperative esotropia was highly associated with postoperative results, we found no association of additional MRR with any of our postoperative outcome measures. The Yokoyama procedure had a higher absolute effect in patients with higher preoperative esotropia. CONCLUSION Our study confirms the positive effect of the Yokoyama procedure on strabismus due to high myopia in large-scale real-world data. In some cases, MRR may be needed because of muscle contracture, although additional MRR statistically did not affect the postoperative outcome. In patients with bilateral high myopic strabismus, correction of both eyes seems beneficial. The effect size of the Yokoyama procedure appears to be mainly driven by preoperative esotropia.
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Affiliation(s)
| | - Julia Fricke
- Department of Ophthalmology University of Cologne Faculty of Medicine and University Hospital Cologne Cologne Germany
| | - Michael Schittkowski
- Department of Ophthalmology Section for Strabismus and Neuroophthalmology University Medicine Goettingen Goettingen Germany
| | - Michael Gräf
- Department of Ophthalmology Justus‐Liebig University Giessen and Universitaetsklinikum Giessen and Marburg GmbH Campus Giessen Giessen Germany
| | - Birgit Lorenz
- Department of Ophthalmology University of Bonn Bonn Germany
- Department of Ophthalmology Justus‐Liebig University Giessen and Universitaetsklinikum Giessen and Marburg GmbH Campus Giessen Giessen Germany
| | - Viktoria Bau
- Medical practice for ophthalmology Department of Ophthalmology Eye Clinic Dresden Friedrichstadt Dresden Germany
| | - Martin M. Nentwich
- Department of Ophthalmology Julius‐Maximilians University Würzburg Würzburg Germany
| | - Abed Atili
- Department Strabism and Oculoplastic Eye‐Clinic‐Esslingen Esslingen Germany
| | - Anja Eckstein
- Department of ophthalmology University Duisburg Essen Essen Germany
| | - Veit Sturm
- Department of Ophthalmology Cantonal Hospital St. Gallen St. Gallen Switzerland
- University of Zurich Zurich Switzerland
| | - Christina Beisse
- Department of Ophthalmology University of Heidelberg Heidelberg Germany
| | - Ina Sterker
- Department of Ophthalmology University of Leipzig Leipzig Germany
| | - Birte Neppert
- Department of Ophthalmology University of Luebeck Luebeck Germany
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Gräf M. [Bridle operation for incomplete oculomotor nerve paralysis (superior rectus and lateral rectus nasal inferior transposition)]. Ophthalmologe 2021; 118:1113-1118. [PMID: 33649921 PMCID: PMC8568859 DOI: 10.1007/s00347-021-01339-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/16/2021] [Accepted: 01/29/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To demonstrate the technique and effectiveness of the bridle operation for oculomotor nerve paralysis with maintained elevation. METHOD The bridle operation includes transposition of the lateral rectus muscle (passing behind inferior oblique and rectus muscles) and the superior rectus muscle (behind superior oblique tendon and medial rectus muscle) to the nasal inferior surface of the globe. RESULTS In the reported case, this procedure corrected exo-hypertropia of 30-40°/20-30° without inducing cyclotropia. CONCLUSION The bridle operation expands the surgical arsenal for paralytic strabismus.
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Affiliation(s)
- Michael Gräf
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Friedrichstr. 18, 35392, Gießen, Deutschland.
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