Long-term results of vertical rectus muscle transposition and botulinum toxin for sixth nerve palsy

Leiba, Hana; Wirth, Gabriela M.; Amstutz, Christoph; Landau, Klara

doi:10.1016/j.jaapos.2010.09.012

Cited by 24 publications

(21 citation statements)

References 18 publications

(27 reference statements)

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“…In previous studies that used unaugmented VRT with BTX, exotropic shift was between 32 and 66 PD, however, some authors have included patients with previous surgery. [4][5][6][7]12,13 In the current study, mean abduction deficit improved from − 4.4 to − 1.8, which seems to be slightly better than most of previously-mentioned transposition procedures. [4][5][6][7]11 Four (13.7%) of our patients were overcorrected.…”

Section: Discussionmentioning

confidence: 46%

Augmented vertical recti transposition with intraoperative botulinum toxin for complete and chronic sixth nerve palsy

Nabie

Andalib

2016

Eye

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Purpose To evaluate the results of augmented vertical rectus muscle transposition (VRT) with intraoperative botulinum toxin (BTX) for complete and chronic sixth nerve palsy. Methods During a 10-year period (2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014) all patients with chronic and complete sixth nerve palsy and contracted medial rectus (MR) who underwent augmented VRT and BTX injection into the MR enrolled in this study. Results In total, 29 patients (5 bilateral) were enrolled in this study. Preoperative deviation was 45 ± 17.5 Prism Diopter (PD), which was improved to − 3.1 ± 13.2 after the operation (Po0.001). Mean preoperative and postoperative abduction limitation was − 4.4 ± 1.1 and − 1.8 ± 0.9, respectively (Po0.001). The success rate was 76% (deviation within 10 PD of orthotropia). Four patients (13.7%) had hypotropia. In 19 patients with preoperative deviation ≤ 45 PD, four patients had consecutive exotropia. Conclusion Intraoperative BTX injection with augmented vertical rectus transposition is an effective procedure. In deviation ≤ 45 there is a risk of overcorrection.

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Section: Discussionmentioning

confidence: 46%

Augmented vertical recti transposition with intraoperative botulinum toxin for complete and chronic sixth nerve palsy

Nabie

Andalib

2016

Eye

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“…This variation often is masked by the tendency for authors to report only the mean postoperative alignment after the procedure as the main measure of the success of the procedure. For example, Leiba and colleagues 12 recently reported a postoperative mean primary position distance alignment of 7.9 Δ ± 8.8 Δ esotropia in their study of the long-term outcome of vertical rectus muscle transposition and botulinum toxin for sixth nerve palsy. Additional analysis of the data, excluding patients with bilateral abducens nerve palsy and with a history of previous recession-resection surgery, reveals the range of exoshift following the procedure to be from 10 Δ to 75 Δ , with a median exoshift of 30 Δ .…”

Section: Discussionmentioning

confidence: 99%

Augmented Hummelsheim procedure to treat complete abducens nerve palsy

Couser

Lenhart

Hutchinson

2012

Journal of American Association for Pediatric Ophthalmology and

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BACKGROUND Horizontal strabismus due to a weak rectus muscle can be treated with an augmented Hummelsheim procedure, in which both vertical rectus muscle tendons are split, resected by 4 mm, and reattached to the sclera adjacent to the weak rectus muscle. Compared with vertical rectus transposition, the procedure spares two ciliary vessels and does not require placement of augmentation sutures. In this study, we evaluated binocular alignment and ocular motility in patients with abducens nerve palsy treated with an augmented Hummelsheim procedure. METHODS The medical records of consecutive patients with complete abducens nerve palsy who underwent the augmented Hummelsheim procedure, usually combined with medial rectus muscle recession, were retrospectively reviewed. Binocular alignment, ocular motility, and complications were analyzed. RESULTS Ten patients (age range, 12–57 years) met inclusion criteria for the study, of whom 9 of 10 had simultaneous medial rectus recession. Follow-up ranged from 1 week to 24 months. The augmented Hummelsheim procedure improved esotropia from 43Δ ± 5Δ preoperatively to 6Δ ± 7Δ postoperatively (P < 0.0001) and reduced abduction deficits from −4 to −3 (P < 0.0001). One patient with coexisting oculomotor nerve palsy developed consecutive exotropia; 2 had induced vertical deviations. There were no cases of anterior segment ischemia. CONCLUSIONS The augmented Hummelsheim procedure combined with medial rectus muscle recession reduced mean primary position esotropia and improved abduction in patients with complete abducens nerve palsy.

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“…Leiba et al reported the longterm follow-up of muscle transposition procedures with botulinum toxin of 22 cases after a mean followup of 44.2 months. 8 Although the effects of the treatment slightly deteriorated during the first year after surgery, results were subsequently maintained. In all cases of our current report, orthophoria was maintained until 8 years postoperatively.…”

Section: Discussionmentioning

confidence: 97%

“…Many previous papers have reported that a muscle transposition procedure was effective for abducens palsy. [1][2][3][4][5][6][7][8] However, the stability of the effectiveness long term has not been revealed because few reports have discussed follow-up for 10 years after a muscle transposition procedure for abducens palsy. [5][6][7] Therefore, we report long-term outcomes (410 years) of three cases that underwent a muscle transposition procedure due to abducens palsy.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Outcomes of Three Cases That Underwent a Muscle Transposition Procedure Without Tenotomy Caused by Abducens Palsy

Higashiyama

Nishida

Muraki

et al. 2014

Neuro-Ophthalmology

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Few reports have discussed long-term outcomes of muscle transposition procedures. In this study, cases with abducens palsy treated with a muscle transposition procedure were followed for 12, 25, or 26 years. The preoperative alignments were esotropia of 65 degrees, 47 prism dioptres (PD), and 24 PD, respectively. Orthophoria was postoperatively achieved in all cases. The postoperative alignment in one case deteriorated at 8 years postoperatively, although orthophoria were maintained in the other two cases. These findings indicate that it is possible that esotropia can recur even though orthophoria was maintained for several years postoperatively in some cases that underwent a muscle transposition procedure.

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Long-term results of vertical rectus muscle transposition and botulinum toxin for sixth nerve palsy

Cited by 24 publications

References 18 publications

Augmented vertical recti transposition with intraoperative botulinum toxin for complete and chronic sixth nerve palsy

Augmented vertical recti transposition with intraoperative botulinum toxin for complete and chronic sixth nerve palsy

Augmented Hummelsheim procedure to treat complete abducens nerve palsy

Long-Term Outcomes of Three Cases That Underwent a Muscle Transposition Procedure Without Tenotomy Caused by Abducens Palsy

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