肌肉联结式移位术治疗单一直肌全麻痹或缺如

我科自 1998年 9月～ 2 0 0 1年 12月采用肌肉联结术治疗一条直肌全麻痹或缺如 9例 ,手术效果较好 ,现报告如下。对象和方法 :1 对象 :9例病例外直肌全麻痹 8例 ( 9只眼 )、先天性下直肌缺如 1例 ( 1只眼 )。患眼向麻痹肌作用方向转动不过中线。其发病原因分别为外伤 5例 ( 6只眼 )、糖尿病 1例、脱髓鞘病 1例、脑血管病 1例 ,最小年龄 2 5岁 ,最大年龄 67岁 ,平均 3 8岁。均为经病因治疗 6个月以上无效者。 2 方法 :术前常规检查视力、屈光间质、眼底角膜映光观察眼位。详查眼球运动及复视像做麻痹肌定性诊断。通过同视机九个诊断眼位同时…     

保留睫状前血管的上下直肌移位术治疗外直肌全麻痹

我们对7例由于颅脑或眼部外伤引起的外直肌麻痹保守治疗6个月仍无改善者，行分离、保留睫状前血管的上下直肌部分移位、内直肌后徙术，术后效果满意，介绍如下。     

水平直肌移位术在斜视治疗中作用

目的 探讨斜视手术中施行水平直肌垂直移位术和转位术的作用.方法 手术前后采用三棱镜遮盖法测定62例斜视患者各诊断眼位的斜视角及眼球运动等,并通过同视机检查和眼底照相评估主客观旋转斜视.手术年龄5～33岁,平均14岁.术后随访1～34个月,平均6个月.结果 (1)不伴有斜肌功能异常V型斜视26例,施行双侧水平直肌同方向垂直移位术或施行单眼水平直肌反方向垂直移位术,分别矫正垂直非共同性10～30△和8-25△,并未发现旋转斜视. (2)伴有斜肌功能异常A型斜视25例,单纯施行水平直肌垂直移位术,可矫正垂直非共同性8～30△,原在位与向下注视之间残留斜视角5～25△,而联合双侧上斜肌减弱术组,残留斜视角2～8△. (3)治疗共同性水平斜视伴有小角度垂直斜视8例,双侧水平直肌的向下或向上移位术矫正上斜视2～8△,残余上斜视2～5△. (4)治疗单眼先天性双上转肌麻痹3例,施行水平直肌垂直转位至上直肌肌止端两侧,矫正垂直斜视角25～30△,残余垂直斜视角5△,眼球双上转运动均明显改善.结论 水平直肌垂直移位术能有效地矫正下斜肌功能无异常V型斜视垂直非共同性,联合双侧上斜肌减弱术能更有效解决A型斜视向下注视的斜视角,而治疗共同性垂直斜视的作用则有一定的局限性;转位术治疗单眼先天性双上转肌麻痹疗效较好.     

一次手术治愈外直肌全麻痹

过去，为了保证前段的血液供应，外直肌全麻痹的手术治疗要分２～３次完成，考虑到全麻痹的外直肌已无功能，我们提出在这种条件下可以不动含睫状前动脉的外直肌，只退后内直肌和将上，下直肌的外侧１／２移到外直肌的附着处，如此安排，可以一次手术完成治疗，这样可以缩短治疗时间，减少病人的痛苦和负担，我们治疗了７例８眼，结果比较满意。     

应用水平直肌移位治疗水平斜视伴垂直斜视

目的探讨水平直肌移位治疗水平斜视伴小角度垂直斜视效果。方法对我院56例（103只眼）水平斜视合并小角度垂直斜视者,在行内、外直肌缩短或徙后手术同时,将附着点上下移位。结果 56例（103只眼）中,30例垂直斜度5-7△,将单眼水平直肌垂直移位5mm,平均矫正垂直斜度5.78±0.57△,疗效较好。21例垂直斜度8-20△将水平直肌垂直上下移位6-7mm,平均矫正垂直斜度6.69±0.91△,其中6例垂直斜度15-20△,欠矫。5例不伴有下斜肌异常V型外斜者,垂直斜度为7-20△,将双眼外直肌徙后并同时向上移位6-7mm,获得较好效果。结论水平肌移位治疗水平斜视伴小角度垂直斜视及不伴有下斜肌异常的V型外斜视获得满意效果。     

直肌移位术治疗麻痹性内斜视的观察

目的 观察上、下直肌移位术治疗麻痹性内斜视的手术效果.方法 回顾分析从1995年5月至2006年5月采用上、下直肌移位联合内直肌后徙术治疗麻痹性内斜视45例(45眼)的手术效果.并依据上、下直肌移位的量分为1/3肌束移位量组和1/2肌束移位量组.两组内直肌后徙量均为7 mm.患者术前检查斜视角及利用弧形视野计记录眼球外转幅度,术后随访1～3 a,统计分析两组对内斜视的矫正度及眼球外转幅度.结果 术后34例矫正至正位,欠矫11例,全部患者外转功能部分恢复,未发生眼并发症.上、下直肌1/3移位量与1/2移位量组对内斜的矫正度差异无显著性(P>0.05),上、下直肌1/2移位量组眼球外转幅度好于1/3移位量组.结论 上、下直肌移位术治疗麻痹性内斜视疗效良好,上、下直肌1/2与1/3移位量对斜视度矫正无明显影响.     

水平直肌移位术治疗A型斜视疗效观察

目的观察水平直肌移位术对A型斜视的治疗效果。方法对26例无明显上斜肌功能亢进的A型斜视患者行单眼或双眼水平直肌移位术,观察术前、术后眼位、眼球运动及双眼视觉情况。结果26例A型斜视患者术后A征消失23例,3例上下转眼位相差在10^△-15^△之间。结论双眼下直肌功能不足是A型斜视的重要原因。对无明显上斜肌功能亢进或上斜肌功能亢进小于＋,水平直肌移位术矫治A型斜视是一种简单有效的方法。     

直肌移位联合改良肌联结术治疗麻痹性内斜视

目的：观察直肌移位联合改良的肌联结术治疗麻痹性内斜视的手术效果。方法对31例（33眼）麻痹性内斜视病人采用直肌移位联合改良加强的肌联结并同时行相应内直肌后徙术治疗。观察术后原在位眼位、代偿头位、眼球运动及复视的改善效果。随访6月~36月,平均14.5月。结果术后26例（27眼）原在位〈＋10△,2例（3眼）欠矫10△以上,3例（3眼）轻度过矫。原在位满意者（＋10△~-10△）占90.9%。术后27例代偿头位矫正。2例残存微小头位。外转过中线5°~20°,平均9°。随访期间过矫的3例恢复。原在位满意者占81.8%。未发现眼前节缺血并发症。结论直肌移位联合改良的肌联结术是一种有效治疗麻痹性内斜视的良好方法。     

单眼双垂直直肌后徙治疗下方垂直斜视

目的探讨单眼双垂直直肌后徙术治疗上斜肌麻痹所致的下方垂直斜视的手术效果.方法利用非麻痹眼的上、下直肌后徙术,对11例上斜肌麻痹所致的下方垂直斜视患者施行手术治疗,术后随访时间3～18个月,平均6个月.结果原在位的垂直斜视度:11例患者均≤4△.正位7例,欠矫2例,过矫2例.上方注视:正位5例,过矫6例(1△～5△),平均3△.下方注视:正位5例,欠矫5例(2△～5△),平均3.5△,1例过矫6△.术后双眼单视功能较术前明显好转,7例患者具有立体视功能.10例患者在主要视野内复视消失,1例患者下方注视有复视,并有异常头位,11例患者均未发生眼睑退缩.结论单眼上、下直肌后徙是治疗上斜肌麻痹所致的下方注视位垂直斜视的有效方法.     

下斜肌前置移位术治疗分离性垂直偏斜

目的 观察下斜肌前置移位术治疗伴有下斜肌亢进的分离性垂直偏斜的临床疗效。方法 下斜肌前置移位于下直肌止端颞侧前２ｍｍ到后２ｍｍ之间。结果 ７例１４只眼,ＤＶＤ程度为１＋（≤１０＾△）的５只眼全部矫正;ＤＶＤ程度为２＋（１１＾△～２０＾△）的８只眼,５只眼全部矫正,２只眼明显改善,１只眼无效;ＤＶＤ程度为３＋（２１＾△～３０＾△）的１只眼无效。结论下斜肌前置移位术矫正伴有下斜肌亢进的分离性垂直偏斜效     

Jensen术治疗外直肌全麻痹

目的:观察Jensen术(直肌联结术)治疗外直肌全麻痹的临床效果.方法:回顾分析1999-05/2006-09采用Jensen术治疗15例外直肌全麻痹患者的手术效果.结果:一次手术后正位14例、欠矫1例二次手术后正位.所有患者外观满意,复视消失、代偿头位消失、第一眼位正位、眼球可外转10°～20°,未发现眼前节缺血现象.结论:Jensen术是治疗外直肌全麻痹的理想方法.     

Vertical rectus muscles transposition in large exotropia with medial rectus muscle transection following endoscopic sinus surgery

PURPOSE: To evaluate the effect of transposition procedures on the vertical rectus muscle (VRM) in the patients who underwent a medial rectus muscle (MR) transection after endoscopic sinus surgery (ESS). METHODS: In 4 patients with exotropia (XT) and a lack of adduction after ESS, orbital CT or MRI revealed a complete transection of the midportion of the MR. Full-tendon VRM transposition was performed within 3 months after injury (early surgery) in 2 patients with 40 delta XT. Two patients with 70 delta and 85 delta XT underwent an X-type augmented Hümmelsheim procedure, which involved pulling each half-tendon and crossing it through the undersurface of the severed MR to the other end of the MR insertion, concurrently with an ipsilateral lateral rectus (LR) recession 11 months and 36 months after ESS, respectively. The adduction deficits were divided into -1 through to -8. The patients were followed up for more than than 1.5 years. RESULTS: Postoperatively, 3 patients showed orthophoria and no diplopia in the primary position. The adduction deficits improved to -3.5 or -4. One patient who underwent an X-type augmented Hümmelsheim procedure showed a residual XT of 25 delta. CONCLUSIONS: VRM transposition is effective in correcting a large XT secondary to a MR transection after ESS. When a longstanding large-angle XT with severe contracture of the ipsilateral LR and massive scarring of the adjacent tissues is present, the X-type augmented Hümmelsheim procedure coupled with an ipsilateral LR recession had an augmenting effect.     

Vertical rectus muscle transposition for bilateral Duane syndrome.

BACKGROUND: Augmented transposition of the superior and inferior rectus muscles to the lateral rectus muscle is effective surgical treatment for esotropia in unilateral Duane syndrome. Medial rectus muscle recession in bilateral Duane syndrome may increase the risk of consecutive exotropia and cause limitation to adduction postoperatively. Vertical rectus muscle transposition may be useful in bilateral Duane syndrome with esotropia. METHODS: We undertook a retrospective review of 11 patients with bilateral Duane syndrome and esotropia in primary position. All patients had vertical rectus muscle transpositions. Six patients had unilateral vertical rectus transpositions (2 eyes with and 4 without suture augmentation). Twelve eyes from 7 children (2 unilateral and 5 bilateral) had transpositions augmented with posterior fixation sutures. Posterior fixation suture were added to large deviations in patients without prior medial rectus recessions. RESULTS: The preoperative esotropia at distance was 22.8 +/- 6.3 prism diopters (PD). It reduced to 2.0 +/- 6.7 PD postoperatively. (P < 0.001) Esotropia at near changed from 21.0 +/- 5.8 PD preoperatively to 1.2 +/- 8.1 PD postoperatively. (P < 0.001) One patient with a 10-degree face turn had complete resolution postoperatively. One patient had a small undercorrection and developed a vertical deviation requiring additional surgery. All patients had improvement in abduction. Nine of 11 patients did not develop any limitation to adduction. One patient developed a -1 adduction deficit 5 years later. Three patients achieved fusion with a mean stereovision of 67 seconds of arc (range, 80-40 seconds.). Follow-up averaged 22.2 months (range, 1-100 months). CONCLUSION: Vertical rectus muscle transposition in patients with bilateral Duane syndrome and esotropia is an effective procedure to improve ocular alignment and motility while preserving adduction.     

Vertical rectus muscle augmented transposition in Duane syndrome.

INTRODUCTION: Reduction or elimination of face turn and esotropia in the primary position while maintaining the largest possible diplopia-free field are the major surgical goals in Duane syndrome with esotropia. Unsatisfactory postoperative results may occur because of limitation in adduction, poor abduction, or induced vertical deviations. Recent reports have shown enhanced results from rectus muscle transposition techniques when a lateral posterior augmentation fixation is placed. METHODS: Preoperative and postoperative data of 2 groups of subjects who had Duane syndrome with esotropia in primary position and markedly reduced abduction were comparatively analyzed. Group A consisted of subjects who had transposition of both vertical rectus muscles to the lateral rectus muscle with a posterior lateral augmentation suture placed in each transposed muscle. Group B subjects had transposition of both vertical rectus muscles to the lateral rectus muscle without the posterior lateral augmentation suture. RESULTS: A total of 32 subjects in group A and 22 subjects in group B were analyzed. In group A, anomalous head position improved 19.1 degrees +/- 10.3 degrees compared with group B subjects who improved 10.6 degrees +/- 5.8 degrees (P <.05). In group A, esotropia in primary position improved 16.4 +/- 9.2 PD compared with group B subjects who improved 8.5 +/- 6.9 PD (P <.05). CONCLUSIONS: Subjects with Duane syndrome and esotropia in primary position who had undergone augmented transposition of the vertical rectus muscles obtained improved head position and better alignment in primary position and had a reduction in the incidence of reoperation for undercorrection when compared with similar patients who had undergone vertical rectus muscle transposition without posterior lateral augmentation sutures.     

Medial transposition of the lateral rectus muscle in experimentally induced medial rectus paralysis

When the oculomotor nerve is completely paralyzed, the affected eye shows severe outward displacement and poor cosmetic appearance. Past results of many surgical procedures for oculomotor palsy have been generally unsatisfactory. We tried a new surgical approach experimentally, in which the disinserted lateral rectus muscle was used as an adductor by medial transposition of the muscle. Five adult cats underwent disinsertion of the medial rectus muscle of both eyes to induce iatrogenic medial rectus paralysis. The disinserted medial rectus was removed as far back as possible to prevent reattachment. Then, the right lateral rectus muscle was disinserted and passed beneath the superior rectus muscle and resutured to the sclera 4mm superoposterior to the medial rectus insertion site. After excision of the bilateral medial rectus, a large exotropia of an average 47.6 delta (42.0-55.5 delta) was induced. The medial transposition of the right lateral rectus produced an average 36.6 delta (24.8-45.8 delta) correction of the exotropia. A satisfactory cosmetic result was achieved by this procedure.     

Vertical rectus muscle transposition and botulinum toxin for complete sixth nerve palsy

BACKGROUND: Effective surgical treatment of complete unrecovered sixth nerve palsy must include the transfer of abducting power to the temporal aspect of the globe with release of medial rectus contracture nasally. We describe our experience in the treatment of five such patients who underwent full vertical rectus transposition combined with botulinum toxin chemodenervation of the ipsilateral medial rectus muscle. METHODS: The five patients all had primarily unilateral complete unrecovered sixth nerve palsy. They all underwent a complete preoperative and postoperative eye examination and an orthoptic assessment. Excursion into abduction was graded from -8 (globe immobilized in extreme adduction) to -4 (abduction as far as primary position) to 0 (full abduction). Abduction saccades and a forced muscle generation test confirmed the presence of complete unrecovered sixth nerve palsy, and forced duction testing measured the degree of medial rectus contracture. All patients received ipsilateral medial rectus injection of botulinum toxin in the preoperative (8 to 2 months before surgery) and perioperative periods, and underwent complete superior rectus-inferior rectus transposition temporally. RESULTS: The average length of follow-up was 21 (range 6 to 48) months. The average preoperative distance alignment was 52 (range 25 to 80) prism dioptres (PD). Vertical rectus transposition combined with botulinum toxin injection resulted in an average distance alignment change of 66 PD (range 50 PD to 82 PD) of exoshift. The average final deviation was 1 PD of esotropia (range 4 PD of esotropia to 6 PD of exotropia). Average abduction improved from -6 (range -3 to -8) preoperatively to -1.7 (range -1 to -2) postoperatively. Saccades averaged -4 preoperatively and improved to -2 postoperatively. Normal vertical eye movements were preserved in all patients. A total field of single binocular vision was created in all patients, which averaged 55 degrees (range 30 degrees to 75 degrees) in the horizontal meridian. The field of single binocular vision from primary position into abduction averaged 23 degrees (range 18 degrees to 28 degrees). INTERPRETATION: Temporal transposition of the vertical rectus muscles combined with perioperative botulinum toxin injection of the ipsilateral medial rectus muscle is a reliable and effective way of restoring functional binocular vision in patients with complete unrecovered sixth nerve palsy.     

Vertical muscle transposition augmented with lateral fixation.

INTRODUCTION: Full vertical rectus muscle transpositions have been shown to be an effective treatment for lateral rectus palsies and type I Duane syndrome. This operation is usually accompanied by mechanical or botulinum toxin treatment of one or both medial rectus muscles. This series evaluates the effect of augmenting the transposed muscles with lateral fixation sutures. METHODS: Transposition of the vertical rectus muscles to the lateral rectus muscle was performed in 23 eyes of 21 patients; transposition to the medial rectus muscle was performed in one eye of one of these 21 patients. A lateral fixation suture of 5-0 Dacron polyester filament was placed in the sclera 16 mm posterior to the limbus and adjacent to the lateral rectus muscle, incorporating one fourth of the transposed vertical rectus muscle. Of the 21 patients, five had type I Duane syndrome with a face turn and esotropia in the primary position, seven had a unilateral lateral rectus palsy, two had bilateral lateral rectus palsy, four had an ipsilateral lateral rectus palsy combined with a contralateral lateral rectus paresis (a recess resect procedure was performed on the paretic eye along with the augmented transposition on the paralyzed eye), two had gaze palsies, and one had a unilateral lateral rectus palsy with recurrent esotropia after a transposition procedure performed 16 years previously. Lateral fixation sutures alone were used in the last case listed. Postoperative diplopia-free fields were measured when possible (10 cases). RESULTS: In most cases (19/23 eyes), alignment was achieved in the primary position with the use of the augmented transposition procedure alone. On average,20 degrees of binocular fusion into the abducted field was obtained. No postoperative limitation of adduction in the transposed eye was noted. Among the patients with Duane syndrome, 80% had elimination of the face turn; one patient had 5 degrees of residual face turn. The one patient with previous transposition surgery alone had an 80% (16 PD) reduction of the recurrent esotropia after placement of lateral fixation sutures. After augmented transpositions, induced vertical deviations in the primary position were uncommon (4/20 patients) and not greater than 2 PD. Significant lid fissure changes were not seen. CONCLUSIONS: The addition of lateral fixation sutures to full vertical rectus muscle transpositions improves the tonic abducting force of the procedure for patients with lateral rectus palsy and type I Duane syndrome without compromising adduction.     

Vertical rectus muscle union combined with lateral rectus plication for complete abducens nerve palsy

International Ophthalmology - The aim of this study was to report our postoperative results concerning the vertical rectus (VR) muscle union combined with lateral rectus (LR) plication for the...