Hummelsheim procedure combined with medial rectus recession in complete sixth nerve palsy and esotropic Duane Retraction Syndrome

2020 ◽  
pp. 112067212097361
Author(s):  
Abbas Bagheri ◽  
Amirreza Veisi ◽  
Mehdi Tavakoli
Keyword(s):  
Nerve Palsy ◽  
Botulinum Toxin Injection ◽  
Rectus Muscle ◽  
Strabismus Surgery ◽  
Medial Rectus ◽  
Prism Diopter ◽  
Sixth Nerve Palsy ◽  
Retraction Syndrome ◽  
Duane Retraction Syndrome ◽  
Sixth Nerve

Purpose: To evaluate the effect of half tendon vertical rectus muscle transposition (HVRT) combined with medial rectus muscle recession (MRrec) in complete sixth nerve palsy (CSNP) and esotropic Duane Retraction Syndrome (eDRS). Methods: A retrospective study of patients with unilateral CSNP or eDRS who underwent HVRT combined with medial rectus recession over the course of 18 years. The patients with previous strabismus surgery and follow up less than 3 months were excluded. Overcorrection was defined as any amount of exotropia, and undercorrection was defined as residual esotropia of ⩾10 prism diopter (PD). Results: A total of 39 patients were enrolled including 22 CSNP and 17 eDRS patients. Esotropia improved from 45.8 ± 22 and 22.5 ± 6.4 PD to 0.8 ± 2.5 and 0.3 ± 1 PD in CSNP group and eDRS group respectively. The angle of face turn improved from 34.3 ± 8.4° and 26.5 ± 9° to 0.6 ± 2.4° and 0.8 ± 1.6° in the CSNP group and eDRS group respectively. Abduction limitation improved from −4.5 ± 0.5 and −4 ± 0 units to −2.9 ± 0.5 and −2.7 ± 0.5 units in CSNP group and eDRS group respectively. No patient developed a new vertical deviation. An overcorrection occurred in one patient of the eDRS group who improved after botulinum toxin injection in the ipsilateral lateral rectus muscle. Undercorrection was seen in two patients. Conclusion: HVRT combined with MRrec is an effective procedure to improve esotropia, face turn, and abduction limitation in CSNP and eDRS.

scholarly journals Augmented superior rectus muscle transposition in management of defective ocular abduction

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mohamed F. Farid ◽  
Ahmed E. M. Daifalla ◽  
Mohamed A. Awwad
Keyword(s):  
Nerve Palsy ◽  
Rectus Muscle ◽  
Muscle Transposition ◽  
Primary Position ◽  
Superior Rectus ◽  
Sixth Nerve Palsy ◽  
Abnormal Head ◽  
Duane Retraction Syndrome ◽  
Sixth Nerve ◽  
Superior Rectus Muscle

Abstract Background Superior rectus muscle transposition (SRT) is one of the proposed transposition techniques in the management of defective ocular abduction secondary to chronic sixth nerve palsy and esotropic Duane retraction syndrome (Eso-DRS). The aim of the current study is to report the outcomes of augmented SRT in treatment of Eso-DRS and chronic sixth nerve palsy. Methods a retrospective review of medical records of patients with Eso-DRS and complete chronic sixth nerve palsy who were treated by augmented full tendon SRT combined with medial rectus recession (MRc) when intraoperative forced duction test yielded a significant contracture. Effect on primary position esotropia (ET), abnormal head posture (AHP), limitation of ocular ductions as well as complications were reported and analyzed. Results a total of 21 patients were identified: 10 patients with 6th nerve palsy and 11 patients with Eso-DRS. In both groups, SRT was combined with ipsilateral MRc in 18 cases. ET, AHP and limited abduction were improved by means of 33.8PD, 26.5°, and 2.6 units in 6th nerve palsy group and by 31.1PD, 28.6°, and 2 units in Eso-DRS group respectively. Surgical success which was defined as within 10 PD of horizontal orthotropia and within 4 PD of vertical orthotropia was achieved in 15 cases (71.4%). Significant induced hypertropia of more than 4 PD was reported in 3 patients (30%) and in 2 patients (18%) in both groups, respectively. Conclusion augmented SRT with or without MRc is an effective tool for management of ET, AHP and limited abduction secondary to sixth nerve palsy and Eso-DRS. However, this form of augmented superior rectus muscle transposition could result in high rates of induced vertical deviation.

scholarly journals Therapeutic results in sixth nerve palsy

2015 ◽  
Vol 22 (1) ◽  
pp. 51-59
Author(s):  
Violeta-Ioana Pruna ◽  
Daniela Cioplean ◽  
Liliana Mary Voinea
Keyword(s):  
Nerve Palsy ◽  
Rectus Muscle ◽  
Lateral Rectus ◽  
Medial Rectus ◽  
Therapeutic Success ◽  
Primary Position ◽  
Sixth Nerve Palsy ◽  
Single Vision ◽  
Binocular Single Vision ◽  
Sixth Nerve

Abstract Authors aim to assess through a retrospective study the efficiency of different therapeutic methods used in VIth nerve palsy. 60 patients with VIth nerve palsy, admitted and treated in Oftapro Clinic, were divided into two groups: a group with partial dysfunction (paresis) of sixth nerve and a group with the complete abolition of neuromuscular function (VIth nerve palsy). Initial examination included assessment of neuromuscular function, binocular vision and existence of medial rectus muscle contracture (ipsi- and contralateral) and contralateral lateral rectus inhibitory palsy. Neuromuscular dysfunction was graded from - 8 (paralysis) to 0 (normal abduction). Therapeutic modalities ranged from conservative treatment (occlusion, prism correction), botulinum toxin chemodenervation and surgical treatment: medial rectus recession + lateral rectus resection, in cases of paresis, and transposition procedures (Hummelscheim and full tendon transfer) in cases of sixth nerve palsy. Functional therapeutic success was defined as absence of diplopia in primary position, with or without prism correction, and surgical success was considered obtaining orthoptic alignment in primary position or a small residual deviation (under 10 PD). 51 patients had unilateral dysfunction, and 9 patients had bilateral VI-th nerve dysfunction. 8 patients had associated fourth or seventh cranial nerves palsy. The most common etiology was traumatic, followed by tumor and vascular causes. There were 18 cases of spontaneous remission, partial or complete (4-8 months after the onset), and 6 cases enhanced by botulinum toxin chemodenervation. 17 paretic eyes underwent surgery, showing a very good outcome, with restoration of binocular single vision. The procedure of choice was recession of medial rectus muscle, combined with resection of lateral rectus muscle. All patients with sixth nerve palsy underwent surgery, except one old female patient, who refused surgery. Hummelscheim procedure was applied in 19 cases, and full tendon transfer in 6 cases. In 13 cases partial results were obtained, who needed further prismatic correction or reintervention. In 12 cases the outcome was very good, with restoration of binocular single vision, without prismatic correction. Therapeutic success in sixth nerve palsy depends on accurate assessment of neuromuscular dysfunction and appropriate choice of therapeutic modality for each case. Interdisciplinary collaboration is mandatory for correct etiologic diagnosis of sixth nerve palsy.

Sixth Nerve Palsy

2011 ◽  
pp. 84-87
Author(s):  
Matthew J. Thurtell ◽  
Robert L. Tomsak ◽  
Robert B. Daroff
Keyword(s):  
Nerve Palsy ◽  
Rectus Muscle ◽  
Thyroid Eye Disease ◽  
Medial Rectus ◽  
Eye Disease ◽  
Sixth Nerve Palsy ◽  
Controversial Topic ◽  
Sixth Nerve

Binocular horizontal diplopia is often due to sixth nerve palsy but can be caused by other conditions, such as restriction of the medial rectus muscle in thyroid eye disease. We review the approach to the patient with sixth nerve palsy in this chapter. We briefly discuss the role of imaging in patients with sixth nerve palsy, as this remains a controversial topic.

Evaluation of augmented temporal superior rectus transposition combined with adjustable medial rectus recession in sixth nerve palsy and esotropic Duane syndrome type 1

2018 ◽  
Vol 22 (4) ◽  
pp. e47
Author(s):  
Adeel Suhail Sethi ◽  
Tobias Emil Torp-Pedersen ◽  
Claes Sepstrup Loenkvist ◽  
Bente Baun Iversen ◽  
Morten Dornonville De La Cour ◽  
...  
Keyword(s):  
Nerve Palsy ◽  
Medial Rectus ◽  
Syndrome Type ◽  
Superior Rectus ◽  
Sixth Nerve Palsy ◽  
Duane Syndrome ◽  
Sixth Nerve

scholarly journals Tendon elongation with bovine pericardium in strabismus surgery—indications beyond Graves’ orbitopathy

2020 ◽  
Vol 259 (1) ◽  
pp. 145-155
Author(s):  
Andrea Hedergott ◽  
Ursula Pink-Theofylaktopoulos ◽  
Antje Neugebauer ◽  
Julia Fricke
Keyword(s):  
Rectus Muscle ◽  
Strabismus Surgery ◽  
Bovine Pericardium ◽  
Prism Diopter ◽  
Type I ◽  
Retraction Syndrome ◽  
Tendon Elongation ◽  
Graves Orbitopathy ◽  
Duane’S Retraction Syndrome

Abstract Background For some patients with complex ocular motility disorders, conventional strabismus surgery is insufficient. Surgery with tendon elongation allows correction of larger angles and maintains a sufficient arc of contact for rectus muscles. This study reports results for tendon elongation with bovine pericardium (Tutopatch®) in indications other than Graves’ orbitopathy in which it is already widely used. Methods We reviewed the records of all patients who underwent surgery with Tutopatch® in our institution. Angles of squint and head postures were analyzed preoperatively, on the first postoperative day, and in the long term (median 9 weeks after the operation). Patients with Graves’ orbitopathy were excluded. Results From 2011 to 2018, the procedures on 58 eyes of 54 patients (35 females, median age 35 years (3–75)) met the inclusion criteria. Horizontal rectus muscle surgery (53 eyes) was conducted on patients with residual strabismus (13), Duane’s retraction syndrome with eso- (type I: 16)/exodeviation (type II: 2, type III: 1), 6th (7)/3rd nerve palsy (7), Möbius syndrome (2), congenital fibrosis of the extraocular muscles type 3A (CFEOM3A, TUBB3 mutation) (4), and orbital apex syndrome (1). Vertical rectus muscle surgery (5 eyes) was conducted on patients with myasthenia (1), vertical tropia after orbital floor fracture (1), CFEOM1 (2), and Parry-Romberg syndrome (1). 42 eyes had prior eye muscle surgery (1–5 procedures, median 1). Out of 45 patients with postoperative long-term data, 43 showed an angle reduction. Fifty-one percent had an angle of 10Δ (prism diopter) or less, one had a significant over-effect, and 10 had revision surgery. For the heterogeneous group of residual eso- and exotropias, the median absolute horizontal angle was reduced from 35Δ (16 to 45Δ) to 9Δ (0 to 40Δ), for Duane’s retraction syndrome from 27.5Δ (9 to 40Δ) to 7Δ (0 to 40Δ), and for sixth and third nerve palsies from 43Δ (20 to 75Δ) to 18Δ (4 to 40Δ). For 3 patients with vertical rectus muscle surgery, the median absolute vertical angle was reduced from 30Δ (20 to 45Δ) to 4Δ (1 to 22Δ). The motility range was shifted in the direction contrary to the elongated muscle in all subgroups. A considerable reduction of the excursion into the field of action of the elongated muscle had to be registered. Conclusions Strabismus surgery with bovine pericardium introduces new surgical options for complicated revisions and for rare and complex oculomotor dysfunctions. Yet, it has to be recognized that this type of surgery aiming at maximum effects, despite preservation or restitution of the arc of contact, leads to reduction of the excursion into the field of action of the elongated muscle. Furthermore, dose finding can be difficult depending on the underlying pathology and more than one intervention might be necessary for optimal results.

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