Vertical Muscle Transposition with Augmentation for Treatment of Exotropia Caused by Iatrogenic Lost Medial Rectus Muscle

Elkamshoushy, Amr; Sayed, Dawood; Sprunger, Derek T.

doi:10.3109/09273972.2016.1159233

Cited by 2 publications

(8 citation statements)

References 21 publications

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“…The mean treatment effects at distance (60 D for DUT alone and 69 D for combined surgery) were the largest, to our knowledge, of previously reported vertical rectus transposition surgeries. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] DUT combined with maximum recession of the antagonist muscle may correct a large deviation (90 D -100 D ), as demonstrated in patients 3 and 7. As for patient 2, the ruptured muscle could have reattached to the globe and improved the duction deficit spontaneously.…”

Section: Discussionmentioning

confidence: 99%

“…The mean correction of this procedure was reported to be 42 D . 2 A number of modifications [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] have been proposed to increase the effect of the surgery while reducing the risk of complications such as anterior segment ischemia. Nevertheless, the expected surgical effects were not adequate to correct a deviation .60 D , which is sometimes associated with severely paralytic strabismus.…”

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confidence: 99%

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Double-under muscle transposition: an effective surgical option for large-angle paralytic strabismus

Furuse

Morisawa

Kobashi

et al. 2021

Journal of American Association for Pediatric Ophthalmology and

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PURPOSETo describe our surgical outcomes using a novel muscle transposition procedure, or double-under muscle transposition (DUT), in the treatment of paralytic strabismus. METHODSIn this surgery, the split halves of the superior and inferior rectus muscles opposite the paralyzed muscle are disinserted, crossed under both the remaining half and the paralyzed muscle, and anchored at opposite corners of the insertion of the paralyzed muscle. The medical records of consecutive patients who underwent DUT were retrospectively reviewed. Outcome measures were angle of deviation and duction deficit. RESULTSSeven patients were included. Diagnoses included WEBINO (n 5 1), rupture of the medial rectus muscle (n 5 1), and abducens nerve palsy (n 5 5). DUT alone was performed in 3 patients; DUT combined with antagonist muscle recession, in 4 patients. One patient underwent the surgery bilaterally. Mean follow-up was 17 AE 181 months (range, 7-57). Preoperative angles of distance deviation ranged from 25 D to 142 D in magnitude. All except a single patient had duction limitation of grade À5. The mean change in distance deviation for DUT alone for each operated eye was 60 D AE 6 D (53 D -65 D ); for combined surgery, 69 D AE 23 D (range, 52 D -103 D ). Final mean angle of deviation at distance was 12 D AE 3 D (À4 D to 0 D ), although an additional surgery was required for large overcorrections in 2 patients. Duction limitation improved in all patients. One patient experienced a postoperative vertical deviation. CONCLUSIONSDUT may be an alternative for patients with severely paralytic strabismus not likely to resolve with previously reported muscle transposition surgeries. Overcorrection may occur in some cases.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Double-under muscle transposition: an effective surgical option for large-angle paralytic strabismus

Furuse

Morisawa

Kobashi

et al. 2021

Journal of American Association for Pediatric Ophthalmology and

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“…The alternative approach to managing an iatrogenic lost muscle is the vertical rectus muscle transposition with either partial or full tendon techniques 15, 16, 17, 18, 19. These approaches could be considered when the proximal part of the lost muscle can not be retrieved, and also in patients with longstanding muscle loss, the involvement of the nerve bundle of the muscle, and lack of the muscle contractility in dynamic MRI 6, 8, 9, 14, 15…”

Section: Discussionmentioning

confidence: 99%

“…It has been shown that the LR muscle weakening by chemo-denervation or surgery may be beneficial in restoration of the alignment after MR loss or damage 9, 17, 18, 28, 29, 30, 31. However, we learned from this patient that even an extreme weakening of the antagonist LR as a sole procedure is not the permanent solution when the MR tonicity is lost.…”

Section: Discussionmentioning

confidence: 99%

“…There are three general approaches to manage this condition including retrieval of the lost muscle,6, 7, 8, 9, 10, 11, 12, 13, 14 transposition of the vertical recti to the MR insertion,15, 16, 17, 18, 19 and anchoring the globe to the nasal orbital wall 11, 20. Herein, the authors report a case of MR loss during the strabismus surgery, followed by successful second stage management with a review of the literature.…”

Section: Introductionmentioning

confidence: 99%

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Medial rectus muscle loss: Is immediate lateral rectus disinsertion a solution? A case report with review of the literature

Bagheri

Abbaszadeh

Tavakoli

2019

Journal of Current Ophthalmology

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PurposeTo report a case of medial rectus (MR) muscle loss during the strabismus surgery with a late successful management and review of the literature.MethodsThe left MR was lost during resection in a 14-year-old girl who had undergone strabismus surgery elsewhere. The surgeon disinserted the antagonist lateral rectus (LR) muscle in the same session following unsuccessful attempts to retrieve the lost muscle. She was referred to our clinic two months later with a large angle exotropia and a complete lack of adduction. We performed a half-tendon transposition of vertical rectus muscles to the MR insertion and attached the residual fibers of the LR to the orbital periosteum.ResultsShe was orthotropic after the surgery and remained stable until 6 months with a significant improvement of the adduction.ConclusionsSimultaneous LR disinsertion is not a solution for MR loss. Half-tendon transposition of the vertical recti to the original insertion of the lost MR and periosteal fixation of the LR are good options as a second-stage operation in patients with MR loss during strabismus surgery.

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Vertical Muscle Transposition with Augmentation for Treatment of Exotropia Caused by Iatrogenic Lost Medial Rectus Muscle

Cited by 2 publications

References 21 publications

Double-under muscle transposition: an effective surgical option for large-angle paralytic strabismus

Double-under muscle transposition: an effective surgical option for large-angle paralytic strabismus

Medial rectus muscle loss: Is immediate lateral rectus disinsertion a solution? A case report with review of the literature

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