Endoscopy ; Female ; Humans ; Middle Aged ; Nose ; surgery ; Oculomotor Muscles ; surgery

When the oculomotor nerve is completely paralyzed, the affected eye shows severe outward displacement and poor cosmetic appearance. Past results of many surgical procedures for oculomotor palsy have been generally unsatisfactory. We tried a new surgical approach experimentally, in which the disinserted lateral rectus muscle was used as an adductor by medial transposition of the muscle. Five adult cats underwent disinsertion of the medial rectus muscle of both eyes to induce iatrogenic medial rectus paralysis. The disinserted medial rectus was removed as far back as possible to prevent reattachment. Then, the right lateral rectus muscle was disinserted and passed beneath the superior rectus muscle and resutured to the sclera 4mm superoposterior to the medial rectus insertion site. After excision of the bilateral medial rectus, a large exotropia of an average 47.6 delta (42.0-55.5 delta) was induced. The medial transposition of the right lateral rectus produced an average 36.6 delta (24.8-45.8 delta) correction of the exotropia. A satisfactory cosmetic result was achieved by this procedure.
Animals ; Cats ; Exotropia/etiology ; Oculomotor Muscles/*surgery ; Oculomotor Nerve Diseases/physiopathology/*surgery ; Vision Disparity

We report the effects of unilateral recession-resection surgery of the horizontal recti muscles with inferior displacement and augmented anterior transposition of the inferior oblique muscle with a posterior intermuscular suture in a patient with large exotropia and considerable hypertropia.
Exotropia/*complications/*surgery ; Humans ; Male ; Middle Aged ; Oculomotor Muscles/*surgery ; Strabismus/*complications/*surgery ; Treatment Outcome

Essential blepharospasm is an incurable disease for which many treatment modalities fave been tried. The author has performed the Anderson's muscle stripping procrdure involving the meticulous extirpation of all eyelid protractors and reinrorcement or the retractors in three patients with essential blerharospasm withgratifying results.
Adult ; Aged ; Blepharospasm/*surgery ; Eyelid Diseases/*surgery ; Female ; Humans ; Middle Aged ; Oculomotor Muscles/*surgery

A large recession of one lateral rectus muscle for exotropia is an infrequently used procedure. In this prospective study, 27 patients (3 to 19 years, mean age of 7) with moderate-angle exodeviation (18-35delta) were treated with large recession (8mm-9mm) of one lateral rectus muscle on their non preferred eye. Initially, there was underaction of the lateral rectus muscle. Within 6 weeks, the lateral rectus muscle regained full abduction, incomitance resolved, and the deviation was eliminated or reduced to a small phoria. Since surgery is confined to the deviating eye alone, operating time, length of anesthesia, and postoperative discomfort is reduced. The average amount of prism diopters needed for correction following operation for 8mm, 8.5mm and 9mm were 20.4delta, 26.4delta, and 31.3delta respectively and esthetically satisfactory results (within 10delta exodeviatior) were obtained in 90.I% of the patients.
Adolescent ; Adult ; Child ; Child, Preschool ; Exotropia/*surgery ; Humans ; Oculomotor Muscles/*surgery ; Prospective Studies ; Strabismus/*surgery

OBJECTIVETo evaluate the treatment effect of the two surgical methods for upper eyelid retraction with thyroid associated-ophthalmopathy.

METHODSTwenty-two patients (32 eyes) with inactive thyroid associated-ophthalmopathy were divided into 2 groups (11 for each group) randomly. 11 patients (18 eyes) in the group A were treated by central tenotomy of levator aponeurosis. Another 11 patients (14 eyes) in the group B were treated by lengthening of Mullers' muscle combined with levator muscle. The treatment effect was investigated in 6-month follow-up study.

RESULTSAll of the patients were improved with the two surgical methods, which there was very significant difference before and after the treatments (P < 0.01), but not between the two surgical methods (P > 0.05) by statistical analysis. There was recurrent retracting in 4 patients (6 eyes) of group A and in 1 patient (1 eye) of group B, which there was significant difference between the two groups (P < 0.05) by Chi-square test. None of the patients was overcorrected.

CONCLUSIONSThe two methods are both effective and safe in correcting upper eyelid retraction. The rate of recurrent retracting is lower in lengthening of Mullers' muscle combined with levator muscle than that in central tenotomy of levator aponeurosis.

Blepharoplasty ; methods ; Eyelid Diseases ; etiology ; surgery ; Female ; Graves Ophthalmopathy ; surgery ; Humans ; Male ; Oculomotor Muscles ; surgery

OBJECTIVE: To summarize the etiology mechanism and treatment of iatrogenic blepharoptosis after double eyelid surgery in Asia. METHODS: To extensively review the literature related to iatrogenic blepharoptosis after double eyelid surgery, and to summarize and analyze the related anatomical mechanism, existing treatment options, and indications. RESULTS: Iatrogenic blepharoptosis is a relatively common complication after double eyelid surgery, sometimes it is combined with other eyelid deformities such as sunken upper eyelid and wide double eyelid, which makes it difficult to repair. The etiology is mainly caused by improper adhesion of tissues and scars, improper removal of upper eyelid tissue, and injury of a link of levator muscle power system. Whether blepharoptosis occurs after double eyelid surgery by incision or suture, it should be repaired by incision. The principles of repair include surgical loosening of tissue adhesion, anatomical reduction, and repair of damaged tissues. The key is to use surrounding tissues or transplanted fat to prevent adhesion. CONCLUSION When repairing iatrogenic blepharoptosis clinically, appropriate surgical methods should be selected based on the causes and severity of the blepharoptosis, combined with treatment principles, in order to achieve better repair results.
Humans ; Blepharoptosis/surgery* ; Treatment Outcome ; Retrospective Studies ; Blepharoplasty/methods* ; Eyelids/surgery* ; Iatrogenic Disease ; Oculomotor Muscles/surgery*

In this study, we explored the neural mechanism underlying impaired stereopsis and possible functional plasticity after strabismus surgery. We enrolled 18 stereo-deficient patients with intermittent exotropia before and after surgery, along with 18 healthy controls. Functional magnetic resonance imaging data were collected when participants viewed three-dimensional stimuli. Compared with controls, preoperative patients showed hypoactivation in higher-level dorsal (visual and parietal) areas and ventral visual areas. Pre- and postoperative activation did not significantly differ in patients overall; patients with improved stereopsis showed stronger postoperative activation than preoperative activation in the right V3A and left intraparietal sulcus. Worse stereopsis and fusional control were correlated with preoperative hypoactivation, suggesting that cortical deficits along the two streams might reflect impaired stereopsis in intermittent exotropia. The correlation between improved stereopsis and activation in the right V3A after surgery indicates that functional plasticity may underlie the improvement of stereopsis. Thus, additional postoperative strategies are needed to promote functional plasticity and enhance the recovery of stereopsis.
Humans ; Exotropia/surgery* ; Depth Perception/physiology* ; Strabismus/surgery* ; Oculomotor Muscles/surgery*

OBJECTIVETo investigate the role of releasing the fibrous bundles across the levator muscle between the medial canthus and lateral canthsus near the top of tarsus in the correction of the congenital blepharoptosis.

METHODSTwenty-seven patients with 40 eyes of blepharoptosis were undergoing the treatment. It was performed by releasing the fibrous bundles across the levator muscle between the medial canthus and lateral canthsus near the top of tarsus to correct the mild and moderate blepharoptosis. A further procedure can also be added to by folding the levator aponeurosis if necessary. In the severe blepharoptosis, the frontalis aponeurose flap may be applied for the suspension as well during the operation.

RESULTSOf the 40 eyes in 27 cases with mild, moderate and severe blepharoptosis were treated by using this method, with 38 eyes corrected satisfactorily and 2 eyes corrected mostly in the following-ups from 3 months to 1 year.

CONCLUSIONThe above mentioned technique may be a good, simple and effect method to corret congenital blepharoptosis.

Adolescent ; Blepharoplasty ; methods ; Blepharoptosis ; congenital ; surgery ; Child ; Eyelids ; surgery ; Facial Muscles ; Humans ; Oculomotor Muscles ; surgery ; Surgical Flaps

OBJECTIVETo investigate the technique and therapeutic effect for correction of sunken eyes combined with ptosis.

METHODSIn order to adjust the levator muscle tension and the relationship between levator aponeurosis and tarsus plate, multiple individualized treatment was selected, including levator aponeurosis restoration, levator aponeurosis plication, or shorten, or combination. Then the orbital fat was transferred to the depressed area, or autologous fat particles were collected and injected into the depressed area within the orbital fat fascia. After the orbital septum fascia was restored, the incision was closed primarily.

RESULTS15 cases (30 eyes) were treated. 11 cases were followed up for 6-40 months (average, 9.5 months) with satisfactory cosmetic and functional result. No recurrence of ptosis happened.

CONCLUSIONSOne-stage correction of sunken eyes combined with ptosis can be achieved with autologous fat injection or orbital fat transposition. Good cosmetic and functional result can be achieved.

Adipose Tissue ; transplantation ; Aged ; Blepharoplasty ; methods ; Blepharoptosis ; surgery ; Eyelids ; Fasciotomy ; Humans ; Oculomotor Muscles ; surgery ; Orbit