Surgical Management of Chronic Complete Sixth Nerve Palsy

Yurdakul, Nazife Sefi; Uğurlu, Şeyda; Maden, Ahmet

doi:10.3928/15428877-20110120-02

Cited by 11 publications

(9 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This type of variation seems to be common in many series, including most types of transposition procedures with or without weakening of the ipsilateral medial rectus muscle. 6,9,13–19 If we consider only the patients with isolated unilateral abducens nerve in our series, we find a mean exoshift of 38 Δ and a median exoshift 36 Δ (range, 28 Δ –53 Δ ). Although a meta-analysis of the literature is beyond the scope of this report, in our experience, results of the augmented Hummelsheim combined with medial rectus muscle recession have been more predictable and uniform than results we observed using other techniques.…”

Section: Discussionmentioning

confidence: 86%

Augmented Hummelsheim procedure to treat complete abducens nerve palsy

Couser

Lenhart

Hutchinson

2012

Journal of American Association for Pediatric Ophthalmology and

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 86%

Augmented Hummelsheim procedure to treat complete abducens nerve palsy

Couser

Lenhart

Hutchinson

2012

Journal of American Association for Pediatric Ophthalmology and

View full text Add to dashboard Cite

show abstract

“…In previous studies, the successful outcomes of full tendon VRT without posterior fixation suture were found to be varied (52%–80%) 1,3,4. To improve the abduction force, lateral fixation suture was introduced by Foster 6.…”

Section: Discussionmentioning

confidence: 99%

“…Sixth cranial nerve palsy is the most common cause of all ocular nerve palsies 1. The etiologies are varied including ischemia, trauma, tumor, increased intracranial pressure, infection, and migraine.…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies on the outcome of full tendon VRT without Foster suture for the treatment of complete sixth cranial nerve palsy achieved good primary position alignment and functional outcome 1,3,4. At present, the outcome and success rate of full tendon VRT with Foster suture are still varied and there is limited information regarding long-term postoperative follow-up 5,6,19,21–23.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

<p>Long-term outcome of full tendon vertical rectus transposition with Foster suture in unilateral complete sixth cranial nerve palsy</p>

Honglertnapakul

Sawanwattanakul

Pukrushpan

et al. 2019

OPTH

View full text Add to dashboard Cite

PurposeTo evaluate the success rate and long-term motor and sensory outcomes of the full tendon vertical rectus transposition (VRT) with Foster suture for unilateral complete sixth cranial nerve palsy.Patients and methodsWe reviewed the medical records of patients with unilateral acquired sixth cranial nerve palsy who underwent unilateral full tendon VRT with Foster suture between 2005 and 2016 and had a follow-up of ≥2 years. Data on pre- and postoperative diplopia, face turn, ocular deviation, and limitation of abduction were collected. A successful outcome was defined as a horizontal deviation ≤10 prism diopter (PD) of ortho in a primary position at distance and absence of diplopia.ResultsA total of 20 patients were included in this study. Median (IQR) preoperative deviation was esotropia 65 (40–130) PD, which improved to 10 (−4 to 45) PD postoperatively. Median (IQR) improvement of esotropia was 54 (30–76) PD (P<0.001). Median (IQR) preoperative limitation of abduction was −15° (−22.5° to 10°; negative value means before reaching midline), which improved to 15° (7.5°–45°) pass midline postoperatively. Median (IQR) improvement of abduction deficit was 26° (15°–35°) (P<0.001). Successful surgical outcomes were obtained in eleven patients (55%). All patients in the non-successful group (n=9, 45%) had residual esotropia. Two of them underwent additional bilateral medial rectus recession. No postoperative vertical deviation or torsional diplopia was observed.ConclusionIn our series, the full tendon VRT with Foster suture in unilateral complete sixth cranial nerve palsy resulted in significant improvement of the ocular alignment and range of abduction over the 2-year follow-up period.

show abstract

“…Some authors prefer to do VRT and MR recession in two separate steps with an interval of at least 6 months. 29 30 The amount of MR recession is calculated using surgical tables in particular situations. For example, for deviations up to 75 PD, 4.5–6 mm of recession seems appropriate.…”

Section: R Esultsmentioning

confidence: 99%

A Review of Transposition Techniques for Treatment of Complete Abducens Nerve Palsy

Akbari

Masoomian

Mirmohammadsadeghi

et al. 2021

Journal of Current Ophthalmology

View full text Add to dashboard Cite

Purpose: To review various types of extraocular muscle transposition procedures for management of strabismus in sixth cranial nerve palsy with little lateral rectus (LR) muscle function, along with their pros and cons. Methods: We performed a comprehensive review of transposition procedures in sixth cranial nerve palsy, based on literature published anytime up to March 2021. A thorough search through PubMed and Cochrane databases was performed. All types of clinical studies on different transposition procedures in LR palsy, were included. Results: Eighty-six original articles in English, with full text or abstracts available, were included in the review, among which 16 are prospective studies, 48 retrospective, 3 review articles, 1 randomized clinical trial, 17 case reports, and 1 letter. Vertical rectus transposition has demonstrated promising results, especially in abduction improvement and expansion of binocular diplopia-free visual field, albeit the possible adverse effects such as anterior segment ischemia, especially in the presence of medial rectus contracture, and induced vertical deviation may become troublesome. Partial muscle transposition, single muscle transposition, and also transposition without tenotomy have all been introduced to reduce the risk of multiple muscle manipulation and ischemia. On the other hand, different adjustable transpositions are being utilized to manage concomitant or induced vertical deviations. Conclusion: Transposition procedures are highly effective in the treatment of esotropia caused by complete LR palsy. Various techniques for vertical muscle transposition have been proposed, with each of them having certain advantages and disadvantages.

show abstract

Surgical Management of Chronic Complete Sixth Nerve Palsy

Abstract: most of the patients with chronic sixth nerve palsy could achieve good ocular alignment with a surgical approach that is tailored according to the needs of the individual patient.

Cited by 11 publications

References 21 publications

Augmented Hummelsheim procedure to treat complete abducens nerve palsy

Augmented Hummelsheim procedure to treat complete abducens nerve palsy

<p>Long-term outcome of full tendon vertical rectus transposition with Foster suture in unilateral complete sixth cranial nerve palsy</p>

A Review of Transposition Techniques for Treatment of Complete Abducens Nerve Palsy

Contact Info

Product

Resources

About