Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus · 2014
Symptomatic excyclotorsion following inferior transposition of both medial rectus muscles in patients with bilateral trochlear nerve palsy.
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Mikhail Michael, Smyth Katherine, Boyle Natalie, Marsh Ian
Аннотация
PURPOSE: To report the development of a large degree of excyclotorsion following inferior transposition of the medial rectus muscles in 5 patients with bilateral acquired trochlear nerve palsies that had previously undergone bilateral modified Harada-Ito procedures.
METHODS: The medical records of 5 patients who had undergone Harada-Ito procedure for bilateral trochlear nerve palsy between 2002 and 2010 and medial rectus muscle infraplacement surgery between 2004 and 2012 were retrospectively reviewed.
RESULTS: All 5 patients underwent a Fells-modified Harada-Ito procedure. All remained symptomatic due to a V pattern (eso- or exodeviation). Bilateral inferior transposition of the medial rectus muscles of either half or full tendon width was performed to alleviate this residual diplopia. The vertical transposition resulted in a symptomatic large degree of excyclotorsion (mean of 20°), which required reversal of the procedure.
CONCLUSIONS: After inferior transposition of both medial rectus muscles in patients with bilateral superior oblique palsy who previously had bilateral modified Harada-Ito surgery, a large excyclotorsion (>20°) can occur. This can be managed by reversing the medial rectus transposition procedure.
METHODS: The medical records of 5 patients who had undergone Harada-Ito procedure for bilateral trochlear nerve palsy between 2002 and 2010 and medial rectus muscle infraplacement surgery between 2004 and 2012 were retrospectively reviewed.
RESULTS: All 5 patients underwent a Fells-modified Harada-Ito procedure. All remained symptomatic due to a V pattern (eso- or exodeviation). Bilateral inferior transposition of the medial rectus muscles of either half or full tendon width was performed to alleviate this residual diplopia. The vertical transposition resulted in a symptomatic large degree of excyclotorsion (mean of 20°), which required reversal of the procedure.
CONCLUSIONS: After inferior transposition of both medial rectus muscles in patients with bilateral superior oblique palsy who previously had bilateral modified Harada-Ito surgery, a large excyclotorsion (>20°) can occur. This can be managed by reversing the medial rectus transposition procedure.