Surgical Results of a Muscle Transposition Procedure for Abducens Palsy Without Tenotomy and Muscle Splitting

Muraki, Sanae; Nishida, Yasuhiro; Ohji, Masahito

doi:10.1016/j.ajo.2013.05.020

Cited by 53 publications

(34 citation statements)

References 17 publications

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“…Other procedures such as the Jensen procedure, vertical rectus muscle splitting with transposition without tenotomy, 23 and vertical rectus muscle transposition without tenotomy as described by Nishida et al 24,25 were not evaluated. Recently, we have adopted the augmented superior rectus muscle transposition with medial rectus muscle recession as described by Mehendale et al; however, this study period did not include those patients.…”

Section: Discussionmentioning

confidence: 99%

Functional and Motor Outcomes of Strabismus Surgery for Chronic Isolated Adult Sixth Nerve Palsy

Peragallo¹,

Hutchinson²,

Lenhart³

et al. 2014

Neuro-Ophthalmology

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Abducens nerve palsy is the most common acquired ocular motor nerve palsy in adults. Chronic cases of abducens palsy often require surgical intervention to relieve disabling diplopia. The goal of this study was to identify factors associated with surgical outcomes in isolated abducens palsy. Medical records of all adult patients from 1988 to 2012 with abducens palsies who underwent strabismus procedures were retrospectively reviewed. Motor alignment, extraocular motility, and sensory outcomes were recorded. Success was defined as absence of diplopia without prisms or face turn, vertical deviation 2 prism dioptres (PD), and horizontal deviation 10 PD. Eighty-one patients (age range: 20-86 years) met inclusion criteria. Success was achieved in 58% of patients. Final success rates for abducens palsy were 50% for neoplastic, 59% traumatic, 57% for microvascular/unknown, and 67% for other central nervous system causes (p40.05). Patients with an underlying neoplastic or traumatic aetiology required more than one strabismus procedure more often than those with microvascular/idiopathic or other central nervous system causes (48% vs. 24%; p = 0.03). For complete abducens palsies, patients who underwent Hummelsheim-type procedures had a higher success rate than those who underwent a full-tendon vertical rectus muscle transposition. (78% versus 35%; p = 0.049). Success rates for strabismus procedures in patients with abducens palsies are similar across all aetiologies. Frequency of re-operation is higher among those patients with neoplastic or traumatic aetiologies for their abducens palsies. Hummelsheim-type procedures have a higher success rate for complete abducens palsies than full-tendon vertical rectus transpositions.

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Section: Discussionmentioning

confidence: 99%

Functional and Motor Outcomes of Strabismus Surgery for Chronic Isolated Adult Sixth Nerve Palsy

Peragallo¹,

Hutchinson²,

Lenhart³

et al. 2014

Neuro-Ophthalmology

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“…[7] This was performed by suturing the lateral muscle belly margins of vertical recti onto the superotemporal or inferotemporal sclera. These sutures transfer the lateral muscle bellies temporally and create additional muscle insertions as new points of action.…”

Section: Discussionmentioning

confidence: 99%

“…described new procedure of “no split and no tenotomy” simple transposition procedure using nonabsorbable suture. [567]…”

mentioning

confidence: 99%

No split, no tenotomy transposition procedure for complete abducens palsy

Murthy

2017

Indian J Ophthalmol

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Abducens palsy is one of the commonly encountered cranial nerve palsies in strabismus clinic. For large-angle esotropia, due to complete abducens palsies, various vertical recti transposition (VRT) procedures have been described. Hummelsheim and Jensen's procedure are especially popular among them. Risk of anterior segment ischemia and induced vertical deviation postVRT prompt to search for better procedures to correct the esotropia and also improve the abduction. Modified Nishida's procedure (no split, no tenotomy transposition) is one of the newly described procedure in this direction. We describe three cases of complete abducens nerve palsy treated by this procedure.

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“…We planned bilateral transposition myopexy on the vertical recti (a modification of the procedure described by Nishida)6. The major modification from the original Nishida’s procedure was that we passed 5–0 non-absorbable braided polyester suture (Ethibond) 8 mm from muscle insertion in both superior rectus (SR) and inferior rectus (IR) full muscle width (against one-third muscle width done in original Nishida’s technique)7 similar to recession suture and transposed it just at the site of absent MR border, 14 mm behind limbus without tenotomy or muscle splitting (figure 3A–E).…”

Section: Surgical Treatmentmentioning

confidence: 99%

Bilateral medial rectus aplasia and a modified surgical approach of transposition myopexy of vertical recti

2017

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A 16-year-old girl presented with left eye large-angle exotropia. On examination, we found bilateral limitation of adduction. CT orbit showed hypoplastic medial rectus bilaterally, but intraoperatively we found absent medial recti on both sides. This case report explains discrepancy between the imaging and the intraoperative findings and discusses the management dilemma in view of the risk of anterior segment ischaemia and how marked exodeviation and adduction limitation was tackled by the new technique of transposition myopexy, a modification of the procedure described by Nishida along with recession of lateral rectus to achieve good alignment. This procedure changes the vector forces of the vertical rectus without splitting or tenotomy of the muscles.

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Surgical Results of a Muscle Transposition Procedure for Abducens Palsy Without Tenotomy and Muscle Splitting

Cited by 53 publications

References 17 publications

Functional and Motor Outcomes of Strabismus Surgery for Chronic Isolated Adult Sixth Nerve Palsy

Functional and Motor Outcomes of Strabismus Surgery for Chronic Isolated Adult Sixth Nerve Palsy

No split, no tenotomy transposition procedure for complete abducens palsy

Bilateral medial rectus aplasia and a modified surgical approach of transposition myopexy of vertical recti

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