Yamada's surgical technique can provide acceptable ocular alignment in cases of myopic strabismus fixus. The surgical effects can be potentialized with resection of the hemitransposed portions of the SR and LR muscles. In addition, we demonstrated that botulinum toxin injection at the RM muscle is not an effective treatment in these cases.
No statistically significant difference was shown between the two groups. Mendonça's forceps can be a safe alternative to electromyography to locate an extraocular muscle for botulinum toxin A injection.
Purpose: To assess ocular and otorhinolaryngologic manifestations and intellectual ability in patients with Möbius' syndrome.
Methods: Patients with Möbius' syndrome underwent prospective ophthalmic, genetic-clinical, and otorhinolaryngologic examinations as well as psychological evaluation.
Results: Sixteen patients with Möbius' syndrome between the ages of 8 months and 10.6 years underwent ocular examination. Esotropia was present in 12 (75%) patients and V-pattern in 8 (50%). Limited abduction was present in 30 (93.8%) eyes, and limited adduction was present in 21 (65.6%) eyes. The most frequent refractive error was compound hyperopic astigmatism (13 [40.6%] eyes). Eleven (68.8%) patients had lagophthalmos and 12 (75%) patients had bilateral epicanthus. Unilateral amblyopia was present in 2 (12.5%) patients. Clubfoot was the most common lower limb defect (7 [43.8%] patients). Cranial nerve impairments included paralysis of 7th nerve in all patients, paralysis of the 12th nerve in 13 patients, and paralysis of the 9th and 10th nerves in 3 patients. Evaluation of intellectual ability showed that 4 (25%) patients had normal intelligence. The mothers of 3 (1 8.8%) patients used misoprostol during the first trimester of pregnancy.
Conclusion: Prominent ophthalmic features of Möbius' syndrome in this series were esotropia, Vpattern, abduction limitation, and compound hyperopic astigmatism. Intellectual assessment showed some degree of mental retardation in 75% of patients. Möbius' syndrome is associated with prenatal exposure to misoprostol.
Journal of Pediatric Ophthalmology and Strabismus 2001;38:156-162.
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