Full-tendon nasal transposition of the vertical rectus muscles: a retrospective review

Congenital dysplasia involving both medial and inferior recti: clinical features and surgical outcomes

AIM

To investigate the clinical features and surgical outcomes of congenital dysplasia involving both inferior recti (IR) and medial recti (MR) muscles.

METHODS

A retrospective review was conducted including cases of simultaneous congenital dysplasia of IR and MR that were diagnosed and surgically treated at the Zhongshan Ophthalmic Center, Sun Yat-sen University, China, from July 2009 to November 2019. Ocular motility, ocular alignment at distance (6 m) and near (33 cm) by prism alternating cover test and stereoacuity were assessed in all patients before and after surgery.

RESULTS

A total of five patients (four males and one female; three with right eye and two with left eye congenital dysplasia) were included in this review. The patients ranged in age from 10 to 42y (21±13.4y). The main clinical findings were hypertropia and exotropia of the affected eye, along with motility limitations in adduction and depression. Lateral rectus (LR) recession/transposition combined with IR resection was performed in one case. Two scheduled surgeries were performed in four cases, with one involving superior rectus recession and IR resection and the others LR recession and MR resection. Mean±SD pre-surgical exotropia of 51.0±31.11 prism diopter (PD) and hypertropia of 29.20±7.12 PD in the primary position were decreased to 3.6±12.90 and 3.2±10.09 PD, respectively, at two years after surgery, with a success rate of 60% and an under-correction rate of 40%.

CONCLUSION

The main clinical features associated with simultaneous MR/IR congenital dysplasia are hypertropia and exotropia of the affected eye along with motility limitations in adduction and depression. Scheduled two-stage surgeries achieved a success rate of 60%.

Aetiology, clinical features and surgical outcomes of isolated medial rectus palsy

IMPORTANCE

Isolated medial rectus palsy is extremely rare in clinical practice.

BACKGROUND

To report demographics, aetiology, clinical findings, imaging features and surgical outcomes in patients with isolated medial rectus palsy.

DESIGN

Retrospective study.

PARTICIPANTS

All patients treated for isolated medial rectus palsy at Zhongshan Ophthalmic Center, Sun Yat-sen University, between September 2003 and March 2019.

METHODS

Review of patient records.

MAIN OUTCOME MEASURES

Aetiology, clinical findings, imaging features and surgical outcomes.

RESULTS

A total of 32 patients (22 males, 10 females) were included. Mean age was 33.19 ± 19.78 years. The right eye was involved in 17 patients, the left eye was involved in 14 patients, and both eyes were involved in one patient. The most common causes were iatrogenic injury (43.75%), followed by trauma (37.50%) and congenital (18.75%). The most common clinical findings included outward deviation, diplopia and limited adduction. Six patients showed combined small-angle vertical strabismus, and 10 patients experienced a scale of -1 motility defect in other directions. After individualized strabismus surgery, preoperative exotropia of 60 ± 25 prism diopters (PD) was significantly reduced to 12 ± 13 PD (t = 10.938, P < .0001). Ocular motility improved in 21 patients, and five patients achieved normal ocular motility. Successful correction was obtained in 20/32 (62.50%) patients, with under-correction in 12/32 (37.50%) patients. Twenty-eight patients had only one surgery, three patients had two surgeries and one patient had three surgeries.

CONCLUSIONS AND RELEVANCE

The most common cause of isolated medial rectus palsy was local injury. Satisfactory results were obtained after individualized surgical interventions based on personalized preoperative evaluations.

Long-term therapeutic outcome of ophthalmic complications following endoscopic sinus surgery

Ophthalmic complications associated with endoscopic sinus surgery (ESS) are quite rare. There is a paucity of reliable data and limited experience on the clinical findings and treatments of these injuries. Our study here is to characterize the types of orbital injury following ESS, in particular extraocular muscle injury, and to evaluate the long-term therapeutic outcomes as compiled from a relatively large sample of Chinese patients.A series of 27 patients (21 males and 6 females; mean age = 42.6 years, ranges: 10-60 years) were retrospectively reviewed. The mean duration of orbital complication was 6.6 months (ranges: 1 day to 24 months). The right eye was affected in 19 patients and the left in 8 patients. All patients had various extraocular muscle dysfunction, including contusion, oculomotor nerve damage, muscle entrapment, muscle transection, and muscle destruction. All patients subjected to strabismus surgery showed an obvious reduction in deviation. Three patients achieved orthophoria without any surgery during the period of observation. All patients displayed mild to complicated orbital hemorrhage that often disappeared within 2 weeks. Optic nerve injury occurred in 29.6% of patients and vision damage in these patients was often irreversible.All patients with ophthalmic complications after ESS had strabismus and extraocular muscle dysfunction. Timing and type of strabismus surgery performed depended on the severity and number of muscles involved as well as the type of injury. This surgery is less effective in cases of restriction factor adhesion and/or entrapment as compared to that of patients with other types of strabismus. Orbital hemorrhages were usually resolved spontaneously, but optic nerve injury was mostly irreversible.

Surgery for complete vertical rectus paralysis combined with horizontal strabismus

Aims. To report outcomes of the simultaneous surgical correction of vertical rectus paralysis combined with moderate-to-large angle horizontal strabismus. Methods. If a preoperative forced duction test was positive, antagonist muscle weakening surgery was performed, and then augmented partial rectus muscle transposition (APRMT) + partial horizontal rectus recession-resection was performed 2 months later. If a preoperative forced duction test was negative, APRMT + partial horizontal rectus recession-resection was performed. Antagonistic muscle weakening surgery and/or conventional recession-resection of the horizontal and/or vertical muscles of the contralateral eye was performed 2 months later, as needed. Results. Ten patients with a mean age of 22.3 ± 13.0 years were included and mean follow-up was 7.1 months. The mean vertical deviation that APRMT corrected was 21.4 ± 3.7 PD (prism diopter). The absolute deviation in horizontal significantly decreased from a preoperative value of 48.5 ± 27.4 PD to a value of 3.0 ± 2.3 PD 6 months postoperatively. The movement score decreased from a value of -5 ± 0 preoperatively to a value of -2.7 ± 0.8 at 6 months postoperatively. Conclusion. For patients with complete vertical rectus paralysis combined with a moderate- to-large angle of horizontal strabismus, combined APRMT and partial horizontal rectus recession-resection is safe and effective for correcting vertical and horizontal strabismus.