A Modified Surgical Technique to Treat Strabismus in Complete Sixth Nerve Palsy
Abstract Introduction A lot of different techniques have been proposed in order to manage abduction limitation secondary to sixth nerve palsy; however, anterior segment ischemia remains a concern. The aim of this study was to evaluate the results of augmented vertical recti muscle transposition (VRT...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Adis, Springer Healthcare
2018-09-01
|
| Series: | Ophthalmology and Therapy |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1007/s40123-018-0143-9 |
| _version_ | 1818469650787205120 |
|---|---|
| author | Nikolaos Kozeis Magdalini Triantafylla Aspasia Adamopoulou Stergiani Veliki Athina Kozei Straton Tyradellis |
| author_facet | Nikolaos Kozeis Magdalini Triantafylla Aspasia Adamopoulou Stergiani Veliki Athina Kozei Straton Tyradellis |
| author_sort | Nikolaos Kozeis |
| collection | DOAJ |
| description | Abstract Introduction A lot of different techniques have been proposed in order to manage abduction limitation secondary to sixth nerve palsy; however, anterior segment ischemia remains a concern. The aim of this study was to evaluate the results of augmented vertical recti muscle transposition (VRT) with partial recession of medial rectus muscle (MR) for complete, chronic sixth nerve palsy, a new modified technique that could also minimize the risk for anterior segment ischemia (ASI). Methods In this nonrandomized 8-year (2009–2017) retrospective review, 20 patients with complete sixth nerve palsy and contracted MR were enrolled. All of them underwent augmented VRT and partial recession of the MR, following a new proposed surgical technique. Only the central part of the MR tendon and belly was recessed by 6.5 mm, leaving 1.5 mm of the upper pole and 1.5 mm of the lower pole of the muscle intact, preserving the circulation of two anterior ciliary arteries. Results Twenty patients with a mean age of 43 years (range 12–71), all unilateral cases, were enrolled in this study. The mean preoperative deviation was 64.25 ± 10.9 prism diopters (PD) base out (range 50 to 90). In 17 cases (88%), the postoperative deviation was within 10 PD of orthotropia. Two patients (10%) had residual esotropia (15 PD and 20 PD, respectively), and one patient (5%) had 10 PD of hypotropia. The mean preoperative abduction limitation of −5.9 improved to −3.1 (p < 0.0001). None of the cases presented with ASI (success rate 100%). Conclusion Partial recession of the MR preserving the two anterior ciliary arteries (Kozeis modified technique) with augmented vertical recti muscle transposition is an effective procedure, with a high success rate and is probably less risky for ASI. |
| first_indexed | 2024-04-13T21:26:27Z |
| format | Article |
| id | doaj.art-e6e5908c54c7457b880b35ca6da35733 |
| institution | Directory Open Access Journal |
| issn | 2193-8245 2193-6528 |
| language | English |
| last_indexed | 2024-04-13T21:26:27Z |
| publishDate | 2018-09-01 |
| publisher | Adis, Springer Healthcare |
| record_format | Article |
| series | Ophthalmology and Therapy |
| spelling | doaj.art-e6e5908c54c7457b880b35ca6da357332022-12-22T02:29:18ZengAdis, Springer HealthcareOphthalmology and Therapy2193-82452193-65282018-09-017236937610.1007/s40123-018-0143-9A Modified Surgical Technique to Treat Strabismus in Complete Sixth Nerve PalsyNikolaos Kozeis0Magdalini Triantafylla1Aspasia Adamopoulou2Stergiani Veliki3Athina Kozei4Straton Tyradellis5Ophthalmica’ Institute of Ophthalmology and MicrosurgeryOphthalmica’ Institute of Ophthalmology and MicrosurgeryOphthalmica’ Institute of Ophthalmology and MicrosurgeryOphthalmica’ Institute of Ophthalmology and MicrosurgeryOphthalmica’ Institute of Ophthalmology and MicrosurgeryOphthalmica’ Institute of Ophthalmology and MicrosurgeryAbstract Introduction A lot of different techniques have been proposed in order to manage abduction limitation secondary to sixth nerve palsy; however, anterior segment ischemia remains a concern. The aim of this study was to evaluate the results of augmented vertical recti muscle transposition (VRT) with partial recession of medial rectus muscle (MR) for complete, chronic sixth nerve palsy, a new modified technique that could also minimize the risk for anterior segment ischemia (ASI). Methods In this nonrandomized 8-year (2009–2017) retrospective review, 20 patients with complete sixth nerve palsy and contracted MR were enrolled. All of them underwent augmented VRT and partial recession of the MR, following a new proposed surgical technique. Only the central part of the MR tendon and belly was recessed by 6.5 mm, leaving 1.5 mm of the upper pole and 1.5 mm of the lower pole of the muscle intact, preserving the circulation of two anterior ciliary arteries. Results Twenty patients with a mean age of 43 years (range 12–71), all unilateral cases, were enrolled in this study. The mean preoperative deviation was 64.25 ± 10.9 prism diopters (PD) base out (range 50 to 90). In 17 cases (88%), the postoperative deviation was within 10 PD of orthotropia. Two patients (10%) had residual esotropia (15 PD and 20 PD, respectively), and one patient (5%) had 10 PD of hypotropia. The mean preoperative abduction limitation of −5.9 improved to −3.1 (p < 0.0001). None of the cases presented with ASI (success rate 100%). Conclusion Partial recession of the MR preserving the two anterior ciliary arteries (Kozeis modified technique) with augmented vertical recti muscle transposition is an effective procedure, with a high success rate and is probably less risky for ASI.http://link.springer.com/article/10.1007/s40123-018-0143-9Anterior segment ischemiaSixth nerve palsySurgery |
| spellingShingle | Nikolaos Kozeis Magdalini Triantafylla Aspasia Adamopoulou Stergiani Veliki Athina Kozei Straton Tyradellis A Modified Surgical Technique to Treat Strabismus in Complete Sixth Nerve Palsy Ophthalmology and Therapy Anterior segment ischemia Sixth nerve palsy Surgery |
| title | A Modified Surgical Technique to Treat Strabismus in Complete Sixth Nerve Palsy |
| title_full | A Modified Surgical Technique to Treat Strabismus in Complete Sixth Nerve Palsy |
| title_fullStr | A Modified Surgical Technique to Treat Strabismus in Complete Sixth Nerve Palsy |
| title_full_unstemmed | A Modified Surgical Technique to Treat Strabismus in Complete Sixth Nerve Palsy |
| title_short | A Modified Surgical Technique to Treat Strabismus in Complete Sixth Nerve Palsy |
| title_sort | modified surgical technique to treat strabismus in complete sixth nerve palsy |
| topic | Anterior segment ischemia Sixth nerve palsy Surgery |
| url | http://link.springer.com/article/10.1007/s40123-018-0143-9 |
| work_keys_str_mv | AT nikolaoskozeis amodifiedsurgicaltechniquetotreatstrabismusincompletesixthnervepalsy AT magdalinitriantafylla amodifiedsurgicaltechniquetotreatstrabismusincompletesixthnervepalsy AT aspasiaadamopoulou amodifiedsurgicaltechniquetotreatstrabismusincompletesixthnervepalsy AT stergianiveliki amodifiedsurgicaltechniquetotreatstrabismusincompletesixthnervepalsy AT athinakozei amodifiedsurgicaltechniquetotreatstrabismusincompletesixthnervepalsy AT stratontyradellis amodifiedsurgicaltechniquetotreatstrabismusincompletesixthnervepalsy AT nikolaoskozeis modifiedsurgicaltechniquetotreatstrabismusincompletesixthnervepalsy AT magdalinitriantafylla modifiedsurgicaltechniquetotreatstrabismusincompletesixthnervepalsy AT aspasiaadamopoulou modifiedsurgicaltechniquetotreatstrabismusincompletesixthnervepalsy AT stergianiveliki modifiedsurgicaltechniquetotreatstrabismusincompletesixthnervepalsy AT athinakozei modifiedsurgicaltechniquetotreatstrabismusincompletesixthnervepalsy AT stratontyradellis modifiedsurgicaltechniquetotreatstrabismusincompletesixthnervepalsy |