Tangential Scleral Myopexy (TSM) as an Alternative to Muscle Resection in Strabismus Treatment

To present the new method as a variant of minimal invasive strabismus surgery (MISS) technique for less invasive and faster reсtus muscle plication. Extraocular muscle strengthening is common for strabismus treatment. Plication as an alternative for tightening or strengthening muscles appears to be less traumatic, quicker and vascular preserving operation. A new plication variant performed by fixating the edge of muscle with 6-0 vicril sutures and pulling them forward and oversewn at 2–3 mm from external part sclera-tendon joint avoiding the anterior ciliary artereies. The distance of muscles advancement depends on the eye deviation angle and calculated by Kenneth Wright charts. In all patients fornix transconjunctival access was performed. Proposed trapezoidal scleral myopexy (TSM) was performed in 26 patients at the age from 3 to 32 years old (children 3–15 y.o. = 29; adults 20–32 y.o. = 7). 23 consecutive patients underwent TSM combined with antagonist recession at the same eye (15 esotropia, 11 exotropia). Follow up period was 6–26 months. The results were considered satisfactory if the postoperative angle was between 0 ± 3° (92.3 %). Only 2 cases (7.6 %) failed to reach this standart. The obtained results considered as very satisfactory. Patients reported only minimal postoperative discomfort and no complain on cosmetics. Trapezoidal muscle plication was inconspicuous throught the conjunctive. The good results of TSM proposed by the author seems to be very simple and more effective for muscle strengthening comparing to resection of medial and lateral rectus muscles. Placement of sutures at the muscle edge during trapezoidal plication exclude ciliary vassel destruction and anterior segment ischemia. The obtained results demonstrated that TSM was considered to be equivalent to resection of horizontal rectus and especially of vertical rectus muscles. Trapezoid form of plication increases the arc of sclera contact to the muscle, probably, explaining the efficiency of proposed operation for muscle strengthening. Proposed modification of muscle plication is reversible, simple, sparing for ciliary artery procedure and is recommended as minimal invasive strabismus surgery (MISS) for simultaneous operation on multiple rectus muscles.

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A Primate Model of Anterior Segment ischemia after Strabismus Surgery

Ophthalmology ◽

10.1016/s0161-6420(90)32561-7 ◽

1990 ◽

Vol 97 (4) ◽

pp. 456-461 ◽

Cited By ~ 24

Author(s):

Peggy H. Fishman ◽

Michael X. Repka ◽

W. Richard Green ◽

Salvatore A. D'Anna ◽

David L. Guyton

Keyword(s):

Anterior Segment ◽

Strabismus Surgery ◽

Primate Model ◽

Anterior Segment Ischemia

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Factors Predisposing to Amblyopia After Exotropia Surgery

ACTA MEDICA IRANICA ◽

10.18502/acta.v59i4.6221 ◽

2021 ◽

Author(s):

Qader Motarjemizadeh ◽

Naser Samadi Aidenloo

Keyword(s):

Visual Acuity ◽

Significant Contribution ◽

Strabismus Surgery ◽

High Rate ◽

Deviation Angle ◽

Age At Surgery ◽

Determining Factors ◽

Lazy Eye ◽

Cox Hazard Model

Amblyopia (lazy eye) is one of the significant complications of strabismus surgery. It is the most important cause of unilateral visual impairment in both children and adults. The current investigation was achieved to determine the postoperative amblyopia rate and to identify factors predisposing to amblyopia following exotropia surgery among patients who had been referred to Imam Khomeini Hospital in Urmia, Iran. The present investigation is a retrospective study that was conducted over three years (2008-2010). The study consisted of sixty patients who underwent their first strabismus surgery for treatment of horizontal deviation. Patients were followed up for at least 24 months, and the rate of postoperative amblyopia was measured. The preoperative deviation, strabismus type (exotropia vs. esotropia), visual acuity, age at surgery , and the number of operated muscles were analyzed as determining factors of postoperative development of amblyopia. Amblyopia was observed in 50% of cases during the follow-up period. No statistically significant differences were observed between amblyopic and non-amblyopic eyes in terms of sex, age at surgery, strabismus type, and visual acuity. But amblyopic eyes showed higher deviation angles compared to nonamblyopic eyes (<0.001). The Cox hazard model analysis revealed a significant contribution of deviation angle to postoperative development of amblyopia. A larger deviation angle has been identified as a positive predictor of postoperative development of amblyopia in our investigated population. Due to such a high rate of postoperative amblyopia, it seems better to initiate and complete amblyopia therapy before strabismus surgery.

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ANTERIOR SEGMENT ISCHEMIA AND STRABISMUS SURGERY: FROM THE ANATOMY TO THE CLINIC. Isquemia del segmento anterior y cirugía del estrabismo: Desde la Anatomía a la Clínica.

Revista Argentina de Anatomía Clínica ◽

10.31051/1852.8023.v7.n1.14158 ◽

2016 ◽

Vol 7 (1) ◽

pp. 44-51

Author(s):

Abraham Olvera-Barrios ◽

Rodrigo E Elizondo Omaña ◽

Verónica E Tamez-Tamez ◽

María de los A. García-Rodríguez ◽

Eliud V Villarreal-Silva ◽

...

Keyword(s):

Risk Factors ◽

Clinical Picture ◽

Surgical Procedure ◽

Preventive Measures ◽

Anterior Segment ◽

Strabismus Surgery ◽

Extraocular Muscles ◽

Factores De Riesgo ◽

Ciliary Arteries ◽

Anterior Segment Ischemia

La isquemia del segmento anterior es una complicación seria que puede presentarse después de la cirugía de estrabismo, particularmente después de desinsertar tres o cuatro músculos extraoculares, con la sección de sus respectivas arterias ciliares anteriores. Sin embargo, susceptibilidad individual y una cantidad considerable de factores de riesgo juegan también un papel importante en el desarrollo de esta condición que pone en peligro la vista. Una evaluación minuciosa es fundamental para cada paciente. Por lo tanto, conocer la irrigación del segmento anterior junto con los mecanismos que producen la isquemia de esta región del ojo es de suma importancia para evaluar a los pacientes, para planear y decidir qué procedimiento quirúrgico es el mejor para cada caso en particular, y para prevenir la ocurrencia de esta complicación. La revisión de la anatomía descriptiva y su posterior correlación con el cuadro clínico de esta entidad facilita el entendimiento de la patogénesis de la isquemia y crea conciencia acerca de la necesidad de instituir medidas preventivas. Anterior segment ischemia is a serious complication that may occur after strabismus surgery, particularly after the deinsertion of three or four extraocular muscles, with transection of their anterior ciliary arteries. However, individual susceptibility and a considerable amount of risk factors also play an important role in the development of this condition, which endangers sight. A thorough evaluation is essential for each patient. Therefore, knowing the irrigation of the anterior segment along with the mechanisms that produce ischemia of the eye region is very important to assess patients, plan and decide which surgical procedure is best for each particular case, and to prevent the occurrence of this complication. Review of the descriptive anatomy and its subsequent combination with the clinical picture of this entity facilitates understanding of the pathogenesis of ischemia and raises awareness about the need to institute preventive measures.

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Effect of monocular surgery for large-angle horizontal deviation in adults

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v3i1.4275 ◽

1970 ◽

Vol 3 (1) ◽

pp. 27-30 ◽

Cited By ~ 3

Author(s):

S Ganguly ◽

R Pradhan

Keyword(s):

Visual Acuity ◽

Large Angle ◽

Anterior Segment ◽

Case Series ◽

Strabismus Surgery ◽

Slit Lamp ◽

Surgical Success ◽

Squint Surgery ◽

Indirect Ophthalmoscope

Background: Surgical success rate of strabismus is variable. Objective: To evaluate the outcome of monocular strabismus surgery for adults with largeangle deviation. Subjects and methods: This study was that of a retrospective interventional case series. A total of 48 consecutive adult patients with large-angle socially-noticeable strabismus underwent clinical evaluation for squint surgery. They were divided into 2 groups of which 28 had exotropia while 20 had esotropia with deviation ranging from 40 to 80 prism diopters (PD). Visual acuity measurement (V/A), cycloplegic refraction and orthoptic evaluation were done in all cases along with detailed anterior segment evaluation. Fundus examination was carried out with indirect ophthalmoscope and slit-lamp bio-microscopy with + 90 D lens. For each case, a repeat evaluation was done after a six-week interval. The surgical procedure was monocular recession and resection carried out under peri-bulbar anesthesia by the same surgeon. Post-operative visual acuity, fusion, stereopsis and ocular alignment were noted in all cases during follow up visits. Results: Successful ocular alignment (< 10 PD) was achieved in 40 patients while binocularity was noted in 3. Forty patients were happy with the cosmetic outcome and psychosocial rehabilitation. No statistically significant improvement was noted in visual acuity and binocular function. Successful alignment was related to pre-operative deviation of less than 30 degrees. Conclusion: Monocular surgery under peri-bulbar anesthesia is a useful procedure for large-angle horizontal strabismus. Key words: strabismus; exotropia; esotropia; fusion; binocularity DOI: 10.3126/nepjoph.v3i1.4275Nepal J Ophthalmol 2011;3(5):27-30

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