Strabismus surgery in the treatment of paralytic strabismus

Outcomes of a Simple Lateral Rectus Belly Transposition Procedure Combined With Ipsilateral Antagonist Recession for Vertical Rectus Palsy

PURPOSE

To report the surgical effects of a combination treatment comprising the lateral rectus belly transposition (LRBT) procedure, without muscle splitting or disinsertion, and ipsilateral antagonist recession for vertical rectus palsy.

METHODS

The medical records of consecutive patients who underwent the LRBT procedure between 2017 and 2020 were reviewed. Preoperative and postoperative deviation in primary position, preoperative and postoperative scale of duction of the palsied muscle, any induced horizontal or torsional deviation, and other complications were collected.

RESULTS

Thirteen patients were identified: 10 with inferior rectus palsy and 3 with superior rectus palsy. The mean postoperative follow-up time was 20.4 ± 8.0 months. Eleven patients (84.6%) underwent simultaneous recession of the ipsilateral antagonist muscle of the palsied vertical rectus. After surgery, the mean vertical deviation improved from 31.4 ± 16.4 to 1.9 ± 3.6 prism diopters (PD) (P < .001). The mean vertical duction limitation of the palsied muscle improved from -2.7 ± 0.6 to -0.6 ± 0.5 (P = .001). In one patient, the scleral fixation suture was removed due to continuous reverse vertical diplopia. The total success rate was 76.9%. No induced horizontal deviation was noted. Anterior segment ischemia or other severe surgical complications did not occur.

CONCLUSIONS

The LRBT procedure can be effective, safe, and reversible in patients with vertical rectus palsy. It allows for the option of simultaneous ipsilateral antagonist recession, and it is especially valuable in patients whose vertical duction deficiency is worse in abduction but mild in adduction. [J Pediatr Ophthalmol Strabismus. 2022;59(6):396-404.].

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.

Lateral rectus belly transposition without tenotomy for acquired inferior rectus weakness: a Case series

We present a new procedure for treating inferior rectus weakness by means of lateral rectus belly transposition, without tenotomy or muscle splitting of the transposed muscle. In this technique, the lower margin of the lateral rectus belly is tied 8 mm posterior to the insertion then transposed to the sclera 2 mm temporal to and 8 mm posterior to the temporal pole of the inferior rectus muscle. We report 3 cases of inferior rectus underaction treated using this procedure. Postoperatively all 3 patients showed complete correction of vertical deviation in primary position and experienced greatly improved depression capacity, without newly induced horizontal or torsional deviation.

Ophthalmic complications of endoscopic sinus surgery

The intimate anatomical relationship between the orbit and the paranasal sinuses places the orbit and its contents at risk of harm from primary pathologic processes of the sinuses. In the absence of ophthalmic signs or symptoms, ophthalmologists are not routinely involved in the management of patients with sinus disease. Occasionally, some patients may develop ophthalmic complaints after surgical intervention. The orbit, optic nerve, extraocular muscles, and lacrimal drainage system are susceptible to injury during endoscopic sinus surgery. The risk of injury is related to the skill of the sinus surgeon, history of previous surgery, extent and severity of disease, and anatomic variation. Furthermore, recent advances in endoscopic sinus surgery, in particular the use of powered cutting instruments, has resulted in a novel mechanism of injury to the ocular structures.