Anterior and nasal transposition of the inferior oblique muscles
| Autor: | David R, Stager, George R, Beauchamp, Weldon W, Wright, Joost, Felius, David, Stager |
|---|---|
| Rok vydání: | 2003 |
| Předmět: |
Adult
Reoperation medicine.medical_specialty Adolescent Pilot Projects Ophthalmologic Surgical Procedures Duane Retraction Syndrome Transplantation Autologous Muscular Diseases Duane syndrome medicine Humans Child Aged Muscle Weakness Ophthalmoplegia Palsy business.industry Retinal Detachment Muscle weakness Retinal detachment Anatomy Middle Aged medicine.disease Magnetic Resonance Imaging Surgery Transplantation Ophthalmology Oculomotor Muscle Oculomotor Muscles Child Preschool Pediatrics Perinatology and Child Health Exotropia medicine.symptom business |
| Zdroj: | Journal of American Association for Pediatric Ophthalmology and Strabismus. 7:167-173 |
| ISSN: | 1091-8531 |
| DOI: | 10.1016/s1091-8531(03)00003-x |
| Popis: | Background When performing anterior transposition of the inferior oblique (IO) muscle, placement of the posterior suture close to the lateral border of insertion of the inferior rectus (IR) muscle decreases the incidence of antielevation syndrome (AES). We hypothesized that placement of the suture nasal to the IR muscle insertion will convert the IO muscle into an intorter and depressor. Here we present the first series of results obtained with a new procedure for the treatment of elevation in adduction with extorsion and abnormal head postures. Methods Twenty patients with IO muscle overaction, superior oblique (SO) muscle palsy, absent SO muscles, AES, or Duane syndrome were studied. Before surgery, each patient showed at least one, but often more, of the following signs: elevation in adduction, exotropia (XT) in up gaze, abnormal head posture, and extorsion. Each underwent anterior and nasal transposition (ANT) of the IO muscle, with the new insertion typically 2 mm nasal and 2 mm posterior to the nasal border of the IR muscle insertion. Results Large improvements in ocular alignment, extorsion, and head posture were found in most patients. However, a poor result was noted in a patient with Y-pattern XT, who developed a mild amount of comitant XT after an extreme degree of ANT (4 mm nasal and 3 mm anterior to the nasal border of the IR muscle insertion). In Duane syndrome, ANT corrects upshoot, but downshoot may get worse. Mersilene permanent sutures, rather than dissolving suture materials, are recommended to avoid postoperative retraction of muscle fibers. Conclusions ANT converts the IO muscle into an intorter and tonic depressor and can significantly improve elevation in adduction. This procedure seems particularly useful in patients with severe or recurrent congenital and acquired SO palsies, particularly as a secondary procedure. Extreme ANT may induce exotropia in the primary position. |
| Databáze: | OpenAIRE |
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