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.

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.

Medial rectus disinsertion for management of chronic complete sixth nerve palsy

2021 ◽  
pp. 112067212110652
Author(s):  
Abbas Bagheri ◽  
Amirreza Veisi ◽  
Mehdi Tavakoli
Keyword(s):  
Nerve Palsy ◽  
Case Series ◽  
Medial Rectus ◽  
Retrospective Case ◽  
Primary Position ◽  
Sixth Nerve Palsy ◽  
Prism Dioptre ◽  
Abnormal Head ◽  
Sixth Nerve

Purpose To report the outcomes of the medial rectus (MR) disinsertion procedure for the management of refractory esotropia (ET) with or without Abnormal head posture (AHP) in chronic complete sixth nerve palsy. Methods This is a retrospective case series of patients with sixth nerve palsy who suffered from residual ET and diplopia following the conventional strabismus surgeries and underwent MR disinsertion procedure between April 2017 and February 2020. This procedure was offered to the patients who declined to use prism and did not wish to perform surgery on the fellow eye. The demographic and clinical data, including sex, age, visual acuity, pre and postoperative angle of strabismus, duction limitations, results of forced duction and force generation tests, details of prior strabismus surgeries, orbital CT scan findings, and follow up duration were collected from the medical records. Results Six patients were enrolled in this study. Mean age was 35.0  ±  14.0 years, and mean follow-up was 15.3  ±  5.9 months. The ET at the Primary position (PP) was 35.0  ±  18.4 prism dioptre (PD) before MR disinsertion, which decreased to 14.2  ±  17.4 PD after MR disinsertion procedure. Four cases needed additional complementary surgeries to improve residual ET in PP. No case developed overcorrection. Abduction deficiency was −5.0  ±  1.3 before MR disinsertion, which improved to − 2.8  ±  0.5 units at last follow-up. The mean of induced adduction deficiency was − 2.9  ±  0.4 at last follow-up. Conclusions MR disinsertion can be considered in patients with chronic complete sixth nerve palsy and refractory diplopia when the conventional methods have failed.

Vertical Rectus Muscle Transposition for Correcting Abduction Deficiency in Duane’s Syndrome Type 1 and Sixth Nerve Palsy

2010 ◽  
Vol 47 (2) ◽  
pp. 96-100 ◽  
Author(s):  
Ziaeddin Yazdian ◽  
Mohammad Taher Rajabi ◽  
Mohammad Ali Yazdian ◽  
Mohammad Bagher Rajabi ◽  
Mohammad Reza Akbari
Keyword(s):  
Nerve Palsy ◽  
Rectus Muscle ◽  
Syndrome Type ◽  
Muscle Transposition ◽  
Sixth Nerve Palsy ◽  
Duane’S Syndrome ◽  
Sixth Nerve

Vertical rectus muscle transposition and botulinum toxin for complete sixth nerve palsy

2001 ◽  
Vol 36 (1) ◽  
pp. 18-25 ◽  
Author(s):  
Michael Flanders ◽  
Faisal Qahtani ◽  
Mark Gans ◽  
Raquel Beneish
Keyword(s):  
Botulinum Toxin ◽  
Nerve Palsy ◽  
Rectus Muscle ◽  
Muscle Transposition ◽  
Sixth Nerve Palsy ◽  
Sixth Nerve
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