Elongation of the inferior rectus tendon with fascia lata graft for large vertical squint angles in patients with Graves’ orbitopathy

Prinz, Julia; Hartmann, Kathi; Migliorini, Filippo; Hamesch, Karim; Walter, Peter; Fuest, Matthias; Kuerten, David

doi:10.1007/s00417-022-05696-5

Cited by 3 publications

(4 citation statements)

References 21 publications

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“…Some specialists have tried using the oblique muscles instead of the medial or lateral recti, [ 39 ] while other specialists studied alternatives aside from utilizing real muscle such as fascia lata especially in patients with complex ocular motility disorders like thyroid eye disease [ 40 ] and congenital innervation disorders for which conventional strabismus surgery is insufficient. Surgery with tendon elongation allows correction of larger angles and is able to maintain a sufficient arc of contact for rectus muscles.…”

Section: Discussionmentioning

confidence: 99%

Extraocular Muscle Transplantation Surgery for Primary Treatment of Extra Large-angle Squint

Adio,

Ezisi,

Nkanga

2024

JOVR

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Purpose: Large-angle horizontal ocular deviations will commonly require bilateral surgery to correct the primary ocular deviation. However, considering the need for full correction with one surgical procedure and patients’ reluctance to be operated on the good eye, such large horizontal ocular deviations may be managed with true muscle transplantation. The authors present a case series of patients who underwent this procedure and develop a surgical table to guide management. Methods: Patients with horizontal squints measuring 80 prism diopters (PD) or larger in all age groups who underwent extraocular muscle transplantation surgery between January 2019 and June 2022 in Nigeria were included. Preoperative deviation of the squint, sensory evaluation, surgical dosage, and outcomes were documented. Part of the resected muscle was transplanted to give additional recession in the antagonist muscle. Success was defined as deviation corrected by 60% or more or postoperative ocular alignment within 10 PD or less, six weeks postoperatively. Results: Fourteen patients with extra-large-angle strabismus were operated. Male/female ratio was 0.6:1. Mean preoperative deviation of 89.6 ± 9.3 collapsed to 6.6 ± 1.8 PD at six weeks and continued to improve to a mean deviation of 2.5 PD at six months postoperatively. When the subgroup of patients who were <18 years were analyzed, the outcome was equally successful; preoperative deviation of 89.4 PD collapsed to 1.4 PD, six months postoperatively. There were equal success rates when those with sensory strabismus were compared with those with binocular vision; preoperative deviation of 92.5 PD in the sensory group and 88.5 PD in the binocular group collapsed to 5.9 PD and 1 PD, respectively, six months after surgery. Conclusion: A viable alternative for treating extra-large-angle strabismus in adults and children in developing countries was described with good postoperative outcome. In addition, a new expanded surgical dosage table for muscle transplantation surgery corrections of up to 130 PD was developed.

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Section: Discussionmentioning

confidence: 99%

Extraocular Muscle Transplantation Surgery for Primary Treatment of Extra Large-angle Squint

Adio,

Ezisi,

Nkanga

2024

JOVR

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“…In contrast, allogenous FL grafts avoid harvest site morbidities [ 37 ]. To date, no relevant host reaction or absorption of the allogenous FL grafts have been reported, which minimizes the possibility of significant over- or under-correction of the LER [ 21 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

“…In 1909, Payr pioneered the use of FL in ophthalmic surgery for the correction of congenital ptosis [ 28 ]. Since then, FL has been used for the treatment of numerous ophthalmic conditions, such as orbital implant extrusion, scleromalacia perforans, cicatricial entropion, and large vertical squint angles in patients with Graves’ orbitopathy [ 21 , 29 , 30 ].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of allogenous fascia lata grafts in the management of lower eyelid retraction

Prinz,

Hartmann,

Migliorini

et al. 2023

Int Ophthalmol

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Purpose To report on the use of allogenous fascia lata (FL) grafts in patients with lower eyelid retraction (LER). Methods In this retrospective study, a consecutive series of 27 patients (39 eyes) with LER who underwent lower eyelid elevation with FL was included. Examinations including measurement of the palpebral fissure vertical height (PFVH), the inferior scleral show distance, the margin reflex distance 2 (MRD 2), and the evaluation of conjunctival hyperemia were conducted at baseline and after a mean postoperative time of 25.9 ± 25.5 (5.0–81.0, median 13.0, last follow-up) months in all patients. Results At the last follow-up, a significant reduction of the PFVH (11.3 ± 1.7 versus 12.8 ± 2.1 at baseline, p < 0.001), the inferior scleral show distance (0.7 ± 1.0 mm versus 2.1 ± 1.1 at baseline, p < 0.001), and the MRD 2 (6.4 ± 0.9 versus 7.8 ± 1.3 at baseline, p < 0.001) occurred. The conjunctival hyperemia grading score (McMonnies) was significantly reduced (1.8 ± 0.7) at the last follow-up compared to baseline (2.6 ± 0.6, p < 0.001). No case of ectropion or entropion was observed at the last follow-up visit. Conclusion In this case series, lower eyelid elevation with FL grafts as a spacer led to a significant reduction of the PFVH, MRD 2, inferior scleral show distance, and conjunctival hyperemia. No severe surgery-related complications occurred.

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“…Other groups have also reported satisfactory results ( 140 , 141 ). To reduce IR muscle restriction, tendon elongation uses homologous scleral grafts, polytetrafluoroethylene (Goretex), silicone, bovine pericardium, ( 142 ), or fascia lata ( 143 ). Jefferis et al ( 127 ) reported favorable outcomes after prioritizing downgaze alignment (rather than primary gaze alignment) to avoid downgaze diplopia.…”

Section: Squint Surgerymentioning

confidence: 99%

Update on the surgical management of Graves’ orbitopathy

et al. 2023

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Graves’ orbitopathy (GO) is a complex autoimmune disorder of the orbit that causes the eye to appear disfigured. GO is typically associated with Graves’ disease, an inflammatory autoimmune condition that is caused by thyrotropin receptor autoantibodies. Although our knowledge of the pathophysiology of GO has improved, its exact pathogenesis remains unclear. Some patients suffer from disfigurement, double vision, and even vision loss rather than hyperthyroidism. The disease severity and activity prompt different treatments, as the signs of GO are heterogeneous, so their management can be very complex. Despite medical advances, the first-line treatment for moderate-to-severe active GO is still glucocorticoids, while surgery can be critical for the treatment of chronic inactive GO. Surgery is sometimes required in the acute phase of the disease when there is an immediate risk to vision, such as in dysthyroid optic neuropathy. Most surgeries for GO are rehabilitative and subdivided into three categories: decompression, strabismus repair, and lid surgery. This review is a basic overview of the field, with up-to-date knowledge of the surgical techniques for GO. We review and summarize recent literature on the advances in surgery for GO to provide up-to-date insights on the optimal surgical treatment for GO.

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Elongation of the inferior rectus tendon with fascia lata graft for large vertical squint angles in patients with Graves’ orbitopathy

Cited by 3 publications

References 21 publications

Extraocular Muscle Transplantation Surgery for Primary Treatment of Extra Large-angle Squint

Extraocular Muscle Transplantation Surgery for Primary Treatment of Extra Large-angle Squint

Efficacy of allogenous fascia lata grafts in the management of lower eyelid retraction

Update on the surgical management of Graves’ orbitopathy

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