ABSTRACT
AIM: To compare the efficacy of Jensen and augmented Hummelsheim procedures in the treatment of complete paralytic esotropia.METHOD: A total of 35 patients(44 eyes)who were diagnosed with complete paralytic esotropia from October 2016 to October 2020 were retrospectively analyzed, of which 15 cases(21 eyes)underwent Jensen procedure combined with recession of antagonist muscle(Jensen procedure group), and 20 cases(23 eyes)received augmented Hummelsheim procedure combined with recession of antagonist muscle(Hummelsheim procedure group). The operation time, preoperative and postoperative esotropia deviation, degree of abduction paralysis, recession of medial rectus muscle and cure rate were observed.RESULTS: Clinical data and operation time of the patients in two groups were not statistically significant(P >0.05). During the last follow-up, the esotropia deviation of Jensen procedure group decreased from 102.33±41.70PD to 3.93±4.82PD(P<0.001), and it decreased from 94.75±33.03PD to 2.85±5.96PD in Hummelsheim procedure group(P<0.001), while the degree of abduction paralysis were significantly improved from -4.81±0.40 to -1.57±0.51 in the Jensen procedure group(P<0.001)and from -4.91±0.29 to -1.22±0.42 in Hummelsheim procedure group(P<0.001). Besides, there was no statistical difference in postoperative esotropia deviation between the two groups(P>0.05), but the degree of postoperative abduction paralysis in the Hummelsheim procedure group was significantly better than that of Jensen procedure group(P<0.05). The recession of medial rectus muscle of the two groups were 7.16±2.07 and 6.37±2.34 mm, respectively(P>0.05). During the last follow-up, in the Jensen procedure group, 2 patients were undercorrection(+10PD and +12PD respectively)and 13 cases(87%)were cured. In the Hummelsheim procedure group, 1 patient was undercorrection(+25PD)and 19 patients were cured(95%), and there was no statistical significance in cure rates of the two groups(P=0.565).CONCLUSIONS: Both Jensen procedure and augmented Hummelsheim procedure can effectively treat complete paralytic esotropia, and the latter is more effective in improving the abduction paralysis.
ABSTRACT
Jensen procedures with medial rectus recession were performed on 13 eyes of 10 patients with lateral rectus palsy caused by trauma. The cases were reviewed retrospectively to assess efficacy of the procedure and long-term stability. After the average 10.2 months of follow-up period, the 7 patients on whom unilateral Jensen procedures and medial rectus muscle recession were performed improved an average of 45.0 delta, and the 3 patients who underwent bilateral Jensen procedures and medial rectus muscle recession improved an average of 82.3 delta. Preoperatively, 12 eyses demonstrated abduction of -4, and 1 eye demonstrated abduction of -1. Postoperatively, abductions of eyes are as follows: 3 eyes -4, 5 eyes -3, 3 eyes -2, and 2 eyes -1. 10 eyes (76.9%) showed improved abduction of lateral rectus muscle, but 3 eyes(23.1%) were not changed. 4 patients(40.0%) acquired a functional area of diplopia free vision, but 6 patients(60.0%) did not, 1 patient developed diplopia postoperatively. No significant cases of vertical deviation were created. One showed anterior segment ischemia, but recovered without complications. Based on these results, the Jensen procedure combined with medial rectus recession is effective in correcting palsies of the lateral rectus muscle that is not recovered.
Subject(s)
Humans , Abducens Nerve Diseases , Diplopia , Follow-Up Studies , Ischemia , Paralysis , Retrospective StudiesABSTRACT
For the 6th nerve paralysis, we use the procedure described by Jensen combined with a 6-7mm recession of the madial rectus muscle. But, anterior segment ischemia(ASI) is an occasional complication of this surgery in which over three rectus muscles are partially or completely detached, ligated. The authors performed this modified Jensen procedure to the patient of 6th nerve paralysis, in which anterior ciliary arteries of vertical rectus muscles were separated from the muscles under the operating microscope and then ligated muscles only. So, this modified procedure preserve the integrity of the anterior ciliary arteries in those portions of the vertical muscles not involved in the muscle union to avoid the danger of anterior segment ischemia.