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

PURPOSE: To investigate the degree of reunion in rabbit eyes of the superior oblique tendon after several surgical weakening procedures. METHODS: A total of 32 rabbits (64 eyes) were used in this study. The rabbits were randomly assigned to four groups, eight rabbits (16 eyes) in the tenotomy group, eight rabbits (16 eyes) in the tenectomy group, eight rabbits (16 eyes) in the disinsertion group and eight rabbits (16 eyes) in the recession group. The degree of reunion or reattachment of the superior oblique tendon on the globe were examined on four eyes in each group at postoperative weeks two, four, six and eight. RESULTS: At eight weeks, the newly created insertion site remained at the same site in all eyes in the recession group, and the distal end of the superior oblique tendon was reattached at the medial border of the superior rectus muscle in all four eyes in the tenotomy and disinsertion groups, and in three of four eyes in the tenectomy group. CONCLUSIONS: From this experimental study, it was speculated that superior oblique recession is more effective than other superior oblique weakening procedures. This result could be helpful in the prediction of time of recurrence for superior oblique overaction after superior oblique weakening procedures.
Animals ; Oculomotor Muscles/*physiopathology/*surgery ; *Ophthalmologic Surgical Procedures ; Prostheses and Implants ; Rabbits ; Silicones ; Tendons/*physiopathology/*surgery ; Wound Healing

PURPOSE: To report an effect of the full tendon transposition augmented with posterior intermuscular suture and recession-resection surgery, for the patient with monocular elevation deficiency (MED) and large exotropia. METHODS: Interventional case report. Full tendon transposition augmented with posterior intermuscular suture and recession-resection surgery was performed for a 26-year-old male patient had monocular elevation deficiency (MED) and large exotropia. RESULTS: Preoperative angle of deviation was 56 prism diopters (PD) hypotropia and 45 PD right exotropia, compared with 18 PD left hypertropia and 10 PD right esotropia postoperatively. Essotropia persisted after 2.5 years, however, and so the right medial rectus was recessed after removal of the previous posterior intermuscular suture. At a three-year follow-up after the second surgery, alignment was straight in the primary position at near and far distances. CONCLUSIONS: Full tendon transposition augmented with posterior intermuscular suture and recession-resection surgery was effective for a patient with MED associated with significant horizontal deviation, and a second operation was easily performed when overcorrection occurred.
Tendon Transfer/*methods ; *Suture Techniques ; Oculomotor Muscles/physiopathology/*surgery ; Male ; Humans ; Follow-Up Studies ; Eye Movements ; Exotropia/physiopathology/*surgery ; Adult

No abstract available.
Child ; Eye Movements/*physiology ; Humans ; Male ; Oculomotor Muscles/physiopathology/*surgery ; Ophthalmologic Surgical Procedures/*methods ; Strabismus/physiopathology/*surgery ; Syndrome

Inverse Duane's retraction syndrome is very uncommon. Congenital cases are even more unusual. A 6-year-old girl with convergent squint along with severe restriction on abduction is described. On attempted abduction, a narrowing of the palpebral fissure, upshoot and retraction of the eyeball were observed. Brain and orbit MRI demonstrated no intracranial or intraorbital mass, fracture, or entrapment of the medial rectus. Forced duction test was strongly positive. The primary lesion was found to be a tight medial rectus with shortening and soft tissue contracture. Surgical tenotomy of the medial rectus led to successful postoperative motility, but some limitation at full adduction and abduction persisted. This is a case reported with congenital medial rectus shortening, suggesting that this condition may be one of the etiologies of the rare inverse Duane's retraction syndrome.
Case Report ; Child ; Contracture/physiopathology ; Contracture/etiology ; Duane Retraction Syndrome/surgery ; Duane Retraction Syndrome/physiopathology ; Duane Retraction Syndrome/congenital* ; Duane Retraction Syndrome/complications ; Eye Movements ; Female ; Human ; Oculomotor Muscles/surgery ; Oculomotor Muscles/physiopathology

In cases of extropia with an exodeviation angle over 50 prism diopter (PD), a 3- or 4-muscle surgery is a rational option. But, in patients with sensory exotropia, there is usually a strong preference for a monocular procedure to avoid surgery on the single seeing eye. Thus, we confined surgery to visually poor eyes, and performed a medial rectus muscle resection with a mean of 10.3 mm (range, 9-11 mm) and a lateral rectus muscle recession with a mean of 12.8 mm (range, 10-14 mm) in 4 adult sensory exotropia patients who had a mean deviation of 82.3 PD (range, 75-90 PD). The mean postoperative angle of exodeviation was 2.0 PD (range, ortho-8 PD). The limitation on abduction was not disfiguring. Other expected disfigurements, such as narrowing of the palpebral fissure or enophthalmos, were not conspicuous. The mean follow-up period was 4.5 months (range, 3-7 months). In large-angle sensory exotropia, instead of additive surgery on the seeing eye, supermaximal medial rectus resection and lateral rectus recession only on the visually poor eye is a clinically feasible surgical option.
Adult ; Exotropia/physiopathology/*surgery ; *Eye Movements ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Oculomotor Muscles/physiopathology/*surgery ; Postoperative Period ; Vision, Ocular

PURPOSE: To analyze the postoperative strabismic angle for five years or more and to investigate when the angle stabilized in intermittent exotropia. METHODS: We retrospectively reviewed the clinical records of 89 patients who had undergone surgery for intermittent exotropia. The postoperative strabismic angles measured were analyzed at one-year intervals up to five years postoperatively. We divided them into two groups according to their age at the time of surgery. Group 1 was less than 5 years of age, while Group 2 participants were 5 years of age or older. RESULTS: For our 89 total patients, average exo-angles were 7.8 +/- 7.26, 7.9 +/- 7.51, 9.5 +/- 7.05, 10.1 +/- 6.87, and 9.4 +/- 6.90 prism diopters at one, two, three, four, and five years postoperatively, respectively. Average exo-angles between postoperative year one and year three, as well as between postoperative year two and year three, were statistically significant (p = 0.015, 0.022). However, the angles were not statistically significant between postoperative year three and year four or between years three and five, respectively (p = 0.707, p = 0.948). The stabilization characteristics of the angle were somewhat different according to age group. In Group 1, the average exo-angle in postoperative years one and three were statistically significant (p = 0.016), but the angle in the same period was not statistically significant in Group 2 (p = 0.203). CONCLUSIONS: There was no significant interval change after three years postoperatively in intermittent exotropia, but if the patient's age at surgery was 5 years or higher, no significant change of exo-angle was found following postoperative year one in this study.
Adolescent ; Child ; Child, Preschool ; Exotropia/physiopathology/*surgery ; Eye Movements/*physiology ; Female ; Follow-Up Studies ; Humans ; Male ; Oculomotor Muscles/physiopathology/*surgery ; Postoperative Period ; *Recovery of Function ; Retrospective Studies ; Treatment Outcome

PURPOSE: To compare postoperative exodrift of the first unilateral lateral rectus (ULR) muscle recession with the exodrift of the second contralateral ULR muscle recession in patients with recurrent small-angle exotropia (XT). METHODS: We evaluated the results of a second ULR muscle recession in 19 patients with recurrent XT with deviation angles under 25 prism diopter (PD), following a first procedure of ULR muscle recession for small-angle XT. Recession of the lateral rectus muscle ranged from 8 to 9 mm. The postoperative motor alignment and degree of exodrift were investigated after the first ULR muscle recession and the second ULR muscle recession in the same patients. RESULTS: Observed differences in postoperative ocular alignment between the first ULR muscle recession and the second ULR muscle recession were statistically significant at follow-up periods of six months (7.84 +/- 4.43 vs. 3.89 +/- 3.47 PD), one year (9.58 +/- 4.97 vs. 5.21 +/- 4.94 PD), and at a final follow-up (21.11 +/- 2.98 vs. 7.52 +/- 4.06 PD) after surgery (p = 0.006, 0.013, and 0.000). Postoperative exodrift was statistically different between the first and second ULR muscle recessions at three to six months (2.89 +/-3.75 vs. 0.63 +/- 3.45 PD) and one year to final follow-up (11.52 +/- 5.50 vs. 2.32 +/- 3.53 PD) (p = 0.034 and 0.000). All of the first ULR muscle recession patients showed XT with deviation angles of more than 15 PD at the final follow-up. Regardless, the surgical success rate (<8 PD) after the second ULR recession was 63.16% (12 patients) among the total amount of patients with recurrent XT. CONCLUSIONS: This study shows that changes in exodrift after a second ULR muscle recession are less than changes after the first URL muscle recession among patients with recurrent XT. A second ULR muscle recession may be a useful surgery for small-angle XT patients with deviation angles of 25 PD or less after a first ULR muscle recession.
Child ; Child, Preschool ; *Exotropia/etiology/physiopathology/surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Oculomotor Muscles/physiopathology/*surgery ; *Ophthalmologic Surgical Procedures ; *Postoperative Complications ; Recurrence ; Retrospective Studies ; Vision, Binocular/physiology

PURPOSE: The purpose of this study is to compare the surgical outcomes and near stereoacuities after unilateral medial rectus (MR) muscle resection and lateral rectus (LR) recession according to deviation angle in basic intermittent exotropia, X(T). METHODS: Ninety patients with basic type X(T) were included in this study. They underwent unilateral recession of the LR and resection of the MR and were followed postoperatively for at least 12 months. Patients were divided into three groups according to their preoperative deviation angle: group 1 < or =20 prism diopter (PD), 20 PD< group 2 <40 PD, and group 3 > or =40 PD. Surgical outcomes and near stereoacuities one year after surgery were evaluated. Surgical success was defined as having a deviation angle range within +/-10 PD for both near and distance fixation. RESULTS: Among 90 patients, groups 1, 2, and 3 included 30 patients each. The mean age in groups 1, 2, and 3 was 9.4 years, 9.4 years, and 11.0 years, respectively. The surgical success rates one year after surgery for groups 1, 2, and 3 were 80.0%, 73.3%, and 73.3% (chi-square test, p = 0.769), respectively. The undercorrection rates for groups 1, 2, and 3 were 16.7%, 23.3%, and 26.7%, and the overcorrection rates were 3.3%, 3.3%, and 0%, respectively. The mean preoperative near stereoacuities for groups 1, 2, and 3 were 224.3 arcsec, 302.0 arcsec, and 1,107.3 arcsec, and the mean postoperative near stereoacuities were 218.3 arcsec, 214.7 arcsec, and 743.0 arcsec (paired t-test; p = 0.858, p = 0.379, p = 0.083), respectively. CONCLUSIONS: In basic X(T) patients, the amount of angle deviation has no influence on surgical outcomes in unilateral LR recession and MR resection. The near stereoacuities by one year after LR recession and MR resection for intermittent X(T) were not different among patient groups separated by preoperative deviation angle.
Child ; Exotropia/physiopathology/*surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Oculomotor Muscles/physiopathology/*surgery ; *Ophthalmologic Surgical Procedures ; Retrospective Studies ; Treatment Outcome ; Vision, Binocular/physiology ; Visual Acuity/physiology

Restriction of eye movement after surgery is an unusual but troublesome complication. A patient presented with a limitation of abduction after a 5 mm resection of medial rectus muscle and an 8 mm recession of lateral rectus muscle. Since the forced duction test was positive, restrictive factors were suggested to be implicated. A reparative operation was performed at the postoperative 9 month, and the forced duction test was negative after releasing the resected medial rectus muscle. The patient showed an improved abduction after recessing the resected muscle. Even after an uneventful surgery, resection of an extraocular muscle may cause restriction of ocular rotation caused by muscle scarring to the sclera or by an increased tightness of the muscle.
Adolescent ; Case Report ; Exotropia/*surgery ; *Eye Movements ; Human ; Male ; Ocular Motility Disorders/*etiology/*physiopathology ; Oculomotor Muscles/*physiopathology/*surgery ; Ophthalmologic Surgical Procedures/*adverse effects ; Postoperative Period