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Vertical rectus muscles transposition in large exotropia with medial rectus muscle transection following endoscopic sinus surgery.

Cho YA, Rah SH, Kim MM, Lee JY - Korean J Ophthalmol (2008)

Bottom Line: Postoperatively, 3 patients showed orthophoria and no diplopia in the primary position.The adduction deficits improved to -3.5 or -4.When a longstanding large-angle XT with severe contracture of the ipsilateral LR and massive scarring of the adjacent tissues is present, the X-type augmented Hümmelsheim procedure coupled with an ipsilateral LR recession had an augmenting effect.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Korea University College of Medicine, Anam Hospital, Seoul, Korea.

ABSTRACT

Purpose: To evaluate the effect of transposition procedures on the vertical rectus muscle (VRM) in the patients who underwent a medial rectus muscle (MR) transection after endoscopic sinus surgery (ESS).

Methods: In 4 patients with exotropia (XT) and a lack of adduction after ESS, orbital CT or MRI revealed a complete transection of the midportion of the MR. Full-tendon VRM transposition was performed within 3 months after injury (early surgery) in 2 patients with 40 delta XT. Two patients with 70 delta and 85 delta XT underwent an X-type augmented Hümmelsheim procedure, which involved pulling each half-tendon and crossing it through the undersurface of the severed MR to the other end of the MR insertion, concurrently with an ipsilateral lateral rectus (LR) recession 11 months and 36 months after ESS, respectively. The adduction deficits were divided into -1 through to -8. The patients were followed up for more than than 1.5 years.

Results: Postoperatively, 3 patients showed orthophoria and no diplopia in the primary position. The adduction deficits improved to -3.5 or -4. One patient who underwent an X-type augmented Hümmelsheim procedure showed a residual XT of 25 delta.

Conclusions: VRM transposition is effective in correcting a large XT secondary to a MR transection after ESS. When a longstanding large-angle XT with severe contracture of the ipsilateral LR and massive scarring of the adjacent tissues is present, the X-type augmented Hümmelsheim procedure coupled with an ipsilateral LR recession had an augmenting effect.

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Related in: MedlinePlus

Patient 3. (A) Preoperatively, fixed large-angle exotropia of 85Δand absent adduction (-7 limitation) of his right eye. (B) Postoperatively, he obtained orthophoria in the primary position and improved adduction to the midline eye.
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Figure 4: Patient 3. (A) Preoperatively, fixed large-angle exotropia of 85Δand absent adduction (-7 limitation) of his right eye. (B) Postoperatively, he obtained orthophoria in the primary position and improved adduction to the midline eye.

Mentions: The initial visit of patients 3 (a 30-year-old man) (Fig. 4 and 5) and 4 (a 63-year-old woman) was 11 months and 3 years after ESS, respectively. In patient 3, a large XT of 85 Δ was shown and the eyeball was not moved nasally with a severe lack of adduction (-8). The FDT in adduction was strongly positive due to the secondary contracture of the antagonist LR and adjacent massive adhesion.


Vertical rectus muscles transposition in large exotropia with medial rectus muscle transection following endoscopic sinus surgery.

Cho YA, Rah SH, Kim MM, Lee JY - Korean J Ophthalmol (2008)

Patient 3. (A) Preoperatively, fixed large-angle exotropia of 85Δand absent adduction (-7 limitation) of his right eye. (B) Postoperatively, he obtained orthophoria in the primary position and improved adduction to the midline eye.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2629931&req=5

Figure 4: Patient 3. (A) Preoperatively, fixed large-angle exotropia of 85Δand absent adduction (-7 limitation) of his right eye. (B) Postoperatively, he obtained orthophoria in the primary position and improved adduction to the midline eye.
Mentions: The initial visit of patients 3 (a 30-year-old man) (Fig. 4 and 5) and 4 (a 63-year-old woman) was 11 months and 3 years after ESS, respectively. In patient 3, a large XT of 85 Δ was shown and the eyeball was not moved nasally with a severe lack of adduction (-8). The FDT in adduction was strongly positive due to the secondary contracture of the antagonist LR and adjacent massive adhesion.

Bottom Line: Postoperatively, 3 patients showed orthophoria and no diplopia in the primary position.The adduction deficits improved to -3.5 or -4.When a longstanding large-angle XT with severe contracture of the ipsilateral LR and massive scarring of the adjacent tissues is present, the X-type augmented Hümmelsheim procedure coupled with an ipsilateral LR recession had an augmenting effect.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Korea University College of Medicine, Anam Hospital, Seoul, Korea.

ABSTRACT

Purpose: To evaluate the effect of transposition procedures on the vertical rectus muscle (VRM) in the patients who underwent a medial rectus muscle (MR) transection after endoscopic sinus surgery (ESS).

Methods: In 4 patients with exotropia (XT) and a lack of adduction after ESS, orbital CT or MRI revealed a complete transection of the midportion of the MR. Full-tendon VRM transposition was performed within 3 months after injury (early surgery) in 2 patients with 40 delta XT. Two patients with 70 delta and 85 delta XT underwent an X-type augmented Hümmelsheim procedure, which involved pulling each half-tendon and crossing it through the undersurface of the severed MR to the other end of the MR insertion, concurrently with an ipsilateral lateral rectus (LR) recession 11 months and 36 months after ESS, respectively. The adduction deficits were divided into -1 through to -8. The patients were followed up for more than than 1.5 years.

Results: Postoperatively, 3 patients showed orthophoria and no diplopia in the primary position. The adduction deficits improved to -3.5 or -4. One patient who underwent an X-type augmented Hümmelsheim procedure showed a residual XT of 25 delta.

Conclusions: VRM transposition is effective in correcting a large XT secondary to a MR transection after ESS. When a longstanding large-angle XT with severe contracture of the ipsilateral LR and massive scarring of the adjacent tissues is present, the X-type augmented Hümmelsheim procedure coupled with an ipsilateral LR recession had an augmenting effect.

Show MeSH
Related in: MedlinePlus