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Application of SRT plus MR recession in supra-maximal esotropia from chronic sixth nerve palsy

  • Yan Liu
  • Wen Wen
  • Leilei Zou
  • Sujia Wu
  • Shu Wang
  • Rui Liu
  • Hong LiuEmail author
Pediatrics
  • 49 Downloads

Abstract

Background

To investigate prognostic factors in patients with augmented superior rectus transposition (SRT) for sixth nerve palsy.

Methods

Thirteen patients who were diagnosed with sixth nerve palsy and underwent augmented SRT between January 2015 and February 2017 in EENT Hospital of Fudan University were reviewed retrospectively. Data including age, sex, etiology of the abducens nerve palsy, degree of pre- and postoperative deviation in the primary position, pre- and postoperative abduction deficit, any induced vertical or torsional deviations, reoperations, and other complications was collected. Patients with undercorrection of SRT surgeries received additional inferior rectus transposition (IRT) surgery.

Results

Mean esodeviation in primary position improved from 81.92 to 30.54 (p < 0.001) with a 1.54-unit improvement in abduction (p = 0.001). Six patients achieved alignment defined as esodeviation in primary position within 10 of orthotropia and seven patients were undercorrected after the first SRT surgery. Multivariable linear regression analysis showed that among factors (disease duration, preoperative esodeviation, preoperative abduction deficit), only the degree of preoperative abduction deficit (β = − 13.68) was the prognostic factor for success of SRT surgery. After IRT procedures, the mean esodeviation in primary position improved from 40 to 8 (p < 0.01).

Conclusion

The degree of preoperative abduction deficit is the prognostic factor for augmented SRT for sixth nerve palsy. Patients with worse abduction deficit have a greater likelihood of needing a secondary operation, and IRT could be a good choice for reoperation after SRT.

Keywords

Sixth nerve Palsy Superior rectus transposition Abduction deficits 

Notes

Funding

This work was supported by the National Nature Science Foundation of China grants (81500752, 81770957) and the Shanghai Committee of Science and Technology Project (134119a8900). The sponsor had no role in the design or conduct of this research.

Compliance with ethical standards

The study was approved by the Institutional Review Board of Eye and ENT Hospital, Fudan University, and followed the Declaration of Helsinki.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

For this type of study, formal consent is not required.

References

  1. 1.
    Murdock TJ, Kushner BJ (2001) Anterior segment ischemia after surgery on 2 vertical rectus muscles augmented with lateral fixation sutures. J AAPOS 5(5):323–324CrossRefGoogle Scholar
  2. 2.
    Simon JW, Grajny A (2004) Anterior segment ischemia following augmented 2-muscle transposition surgery. J AAPOS 8(6):586–587CrossRefGoogle Scholar
  3. 3.
    Johnston SC, Crouch ER Jr, Crouch ER (2006) An innovative approach to transposition surgery is effective in treatment of Duane’s synreome with esotropia [ARVO abstract]. Invest Ophthalmol Vis Sci 47(e-abstract):2475Google Scholar
  4. 4.
    Foster RS (1997) Vertical muscle transposition augmented with lateral fixation. J AAPOS 1(1):20–30CrossRefGoogle Scholar
  5. 5.
    Holmes JM, Hatt SR, Leske DA (2012) Intraoperative monitoring of torsion to prevent vertical deviations during augmented vertical rectus transposition surgery. J AAPOS 16(2):136–140CrossRefGoogle Scholar
  6. 6.
    Akar S, Gokyigit B, Pekel G, Demircan A, Demirok A (2013) Vertical muscle transposition augmented with lateral fixation (Foster) suture for Duane syndrome and sixth nerve palsy. Eye 27(10):1188–1195CrossRefGoogle Scholar
  7. 7.
    Paysse EA, Brady McCreery KM, Ross A, Coats DK (2002) Use of augmented rectus muscle transposition surgery for complex strabismus. Ophthalmology 109(7):1309–1314CrossRefGoogle Scholar
  8. 8.
    Yazdian Z, Rajabi MT, Ali Yazdian M, Rajabi MB, Akbari MR (2010) Vertical rectus muscle transposition for correcting abduction deficiency in Duane’s syndrome type 1 and sixth nerve palsy. J Pediatr Ophthalmol Strabismus 47(2):96–100CrossRefGoogle Scholar
  9. 9.
    Flanders M, Qahtani F, Gans M, Beneish R (2001) Vertical rectus muscle transposition and botulinum toxin for complete sixth nerve palsy. Can J Ophthalmol 36(1):18–25CrossRefGoogle Scholar
  10. 10.
    Rosenbaum AL, Kushner BJ, Kirschen D (1989) Vertical rectus muscle transposition and botulinum toxin (Oculinum) to medial rectus for abducens palsy. Arch Ophthalmol 107(6):820–823CrossRefGoogle Scholar
  11. 11.
    Mehendale RA, Dagi LR, Wu C, Ledoux D, Johnston S, Hunter DG (2012) Superior rectus transposition and medial rectus recession for Duane syndrome and sixth nerve palsy. Arch Ophthalmol 130(2):195–201CrossRefGoogle Scholar
  12. 12.
    Yang S, MacKinnon S, Dagi LR, Hunter DG (2014) Superior rectus transposition vs medial rectus recession for treatment of esotropic Duane syndrome. JAMA Ophthalmol 132(6):669–675CrossRefGoogle Scholar
  13. 13.
    Velez FG, Oltra E, Isenberg SJ, Pineles SL (2014) Assessment of torsion after superior rectus transposition with or without medial rectus recession for Duane syndrome and abducens nerve palsy. J AAPOS 18(5):457–460CrossRefGoogle Scholar
  14. 14.
    Lee YH, Lambert SR (2017) Outcomes after superior rectus transposition and medial rectus recession versus vertical recti transposition for sixth nerve palsy. Am J Ophthalmol 177:100–105CrossRefGoogle Scholar
  15. 15.
    Patil-Chhablani P, Kothamasu K, Kekunnaya R, Sachdeva V, Warkad V (2016) Augmented superior rectus transposition with medial rectus recession in patients with abducens nerve palsy. J AAPOS 20(6):496–500CrossRefGoogle Scholar
  16. 16.
    Bleik JH, Cherfan GM (1995) Anterior segment ischemia after the Jensen procedure in a 10-year-old patient. Am J Ophthalmol 119(4):524–525CrossRefGoogle Scholar
  17. 17.
    Bansal RK, Bamotra RK (2015) Anterior segment ischemia following Hummelsheim procedure in a case of sixth nerve palsy. Indian J Ophthalmol 63(6):543–544CrossRefGoogle Scholar
  18. 18.
    Rosenbaum AL (2004) Costenbader lecture. The efficacy of rectus muscle transposition surgery in esotropic Duane syndrome and VI nerve palsy. J AAPOS 8(5):409–419CrossRefGoogle Scholar
  19. 19.
    McManaway JW 3rd, Buckley EG, Brodsky MC (1990) Vertical rectus muscle transposition with intraoperative botulinum injection for treatment of chronic sixth nerve palsy. Graefes Arch Clin Exp Ophthalmol 228(5):401–406CrossRefGoogle Scholar
  20. 20.
    Velez FG, Foster RS, Rosenbaum AL (2001) Vertical rectus muscle augmented transposition in Duane syndrome. J AAPOS 5(2):105–113CrossRefGoogle Scholar
  21. 21.
    Britt MT, Velez FG, Velez G, Rosenbaum AL (2005) Vertical rectus muscle transposition for bilateral Duane syndrome. J AAPOS 9(5):416–421CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Yan Liu
    • 1
    • 2
    • 3
    • 4
  • Wen Wen
    • 1
    • 2
    • 3
    • 4
    • 5
  • Leilei Zou
    • 1
    • 2
    • 3
    • 4
  • Sujia Wu
    • 1
    • 2
    • 3
    • 4
  • Shu Wang
    • 1
    • 2
    • 3
    • 4
  • Rui Liu
    • 1
    • 2
    • 3
    • 4
  • Hong Liu
    • 1
    • 2
    • 3
    • 4
    Email author
  1. 1.Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Shanghai Medical CollegeFudan UniversityShanghaiChina
  2. 2.State Key Laboratory of Medical Neurobiology, Institutes of Brain ScienceFudan UniversityShanghaiChina
  3. 3.Key Laboratory of Myopia, Ministry of HealthFudan UniversityShanghaiChina
  4. 4.Shanghai Key Laboratory of Visual Impairment and RestorationFudan UniversityShanghaiChina
  5. 5.State Key Laboratory of Brain and Cognitive Science, Institute of BiophysicsChinese Academy of SciencesBeijingChina

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