Application of rectus muscle transplantation optimization for refractory single eye insufficiency / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the application of rectusmuscle transplantation optimization in the treatment of refractory supraventricular insufficiency in one eye caused by double supraventricular paralysis with inferior rectus restriction and high original vertical strabismus. <p>METHODS: Retrospective analysis was performed on 6 cases of double superior muscle palsy admitted to our hospital from January 2015 to January 2019. After the failure of conservative treatment, rectus muscle transplantation optimization was adopted to observe the improvement of preoperative and postoperative eye position, vertical strabismus, motor function of upper and lower rotation of paralytic eye, as well as the improvement of pseudo ptosis and compensated head position. <p>RESULTS: After the restriction was lifted, rectusmuscle transplantation optimization was performed. The original <i>in situ</i> vertical strabismus degree before surgery, one month and six months after surgery were(49.83 ± 6.55)PD,(2.67±2.07)PD, and(1.83±2.40)PD. There was a significant difference in vertical strabismus before and after 1mo and 6mo of operation(<i>P</i><0.001). There was no significant difference in the comparison of vertical strabismus between 1mo and 6mo of operation(<i>P</i>=0.899). All patients had the orthotopic position in postoperative position, and the paralysis function of the paralyzed eyes improved significantly after the operation; Pseudopterygoptosis in four cases and compensatory head position in two cases before operation were significantly improved after operation. <p>CONCLUSION: Optimization of rectus muscle transplantation is suitable for unilateral superior rotation deficiency with limitation of inferior rectus, which can effectively improve the superior rotation function of affected eye with stable curative effect.

Clinical observation of monocular rectus surgery for adult sensory exotropia / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To evaluate the effect of monocular rectus surgery for adult sensory exotropia. <p>METHODS: Totally 76 cases of adult sensory exotropia of degree -15^△ to -160^△(-68.36^△±30.77^△)examined through Krimsky method were included into this study. A total of 16 cases, 37 cases and 23 cases with different degrees of strabismus were treated separately with routine amount monocular lateral rectus recession, routine amount monocular medial rectus resection plus lateral rectus recession, and exceed constant amount monocular medial rectus resection plus lateral rectus recession. Follow-up was performed at 1d, 1wk, 1, 3 and 6mo after operation. The eye position, monocular movement, intraocular pressure(IOP), slit lamp, and fundus of these patients were examined. <p>RESULTS:After surgery, 67 cases(88%)were positive and 9 cases(12%)were undercorrection. The postoperative intraocular pressure of operative eye at 1wk was equal to preoperative(<i>P</i>=0.090), and IOP decreased to a valley value at 1mo(<i>P</i><0.01), there was no significant difference in intraocular pressure between 3mo and 1mo(<i>P</i>=0.092), and no significant difference in intraocular pressure between 6mo and 3mo(<i>P</i>=0.123). And 2 cases(3%)had inflammatory reaction induced by anterior segment ischemia at 1d and 1wk postoperative visits, and they recovered at 1mo follow-up visit; 4 cases(5%)experienced an external dysfunction at the 1, 3 and 6mo follow-up. <p>CONCLUSION:Monocular rectus surgery has a good therapeutic effect on adult patients with sensory exotropia; the decrease in intraocular pressure secondary to the detached rectus is worth the attention of the surgeon; the incidence of complications after detaching monocular of two rectus muscles is comparable low. Exceed constant amount rectus strabismus surgery for sensory exotropia may result in limited function of postoperative ocular hyperextension.

Effect of modified inferior oblique anterior transposition on dissociated vertical strabismus patients with inferior oblique muscle hyperfunction / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the effect of anterior transposition of inferior oblique muscle on the treatment of dissociated vertical deviation(DVD)in children with inferior oblique overaction(IOOA)and unequal inferior oblique transposition of the treatment of IOOA with the eyes of the asymmetry of DVD efficacy, associated with the lower oblique hyperfunction DVD patients to provide more effective treatment. <p>METHODS: Eighty patients with hyperfunction who were treated in our hospital from January 2014 to December 2015 were randomly selected and treated with anterior transposition of inferior oblique muscle. Patients were followed up for 1 to 30mo. We compared the vertical incline at the original incline from far(5m), near(33cm)distance and IOOA degree before and after operations, and the correlation between the two. We also compared the vertical incline at the original incline from far(5m), near(33cm)distance and IOOA degree before and after operations in 30 eyes(20 patients)with bilateral asymmetry DVD and IOOA who received unequal inferior oblique transposition. The incidence of antielevation syndrome(AES)was observed after operations. <p>RESULTS: The mean prism diopters(PD)at 5m before operations was 19.5±0.15, the average PD after operations was 3.5±0.18, at 5m the original incline was 16±0.21PD. The mean PD at 33cm was 18.6±0.20 before operation, 4.5±0.26 after operations, and 14.1±0.16 at 33cm the original incline, the difference was statistically significant(<i>P</i><0.05). Preoperatively, inferior oblique muscle hyperfunction +2 and +3 was 50 eyes, + 1 was 20 eyes, and 12 eyes still showed inferior oblique muscle hyperfunction after operation, but the degree of hyperactivity was +1. There was a significant positive correlation between the degree of IOOA and the vertical inclination(33cm: <i>r</i>=0.554, <i>P</i><0.01; 5m: <i>r</i>=0.454, <i>P</i> <0.01). There were significant differences(<i>P</i><0.05)in the vertical incline in 20 patients(30 eyes)with bilateral asymmetry DVD and IOOA and the degree of IOOA was significantly lower. In contrast, 18 patients(24 eyes)underwent anterior transposition of the inferior oblique muscle had AES in different degrees, which had statistically significant difference(<i>P</i><0.05)compared with patients(30 eyes)with IOOA treated with unequal inferior oblique transposition. <p>CONCLUSION: Anterior transposition of the inferior oblique muscle has a good therapeutic effect on isolated vertical strabismus patients with inferior oblique hyperfunction. While the incidence of postoperative AES is low in patients received unequal inferior oblique muscle transposition.

Efficacy comparison of combined and single operation for senile lower eyelid entropion / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To compare the clinical effect of the lower eyelid retractor muscle transposition and eyelid orbicularis muscle folding shorten combined with lower eyelid retractor muscle transposition in the treatment of senile lower eyelid entropion. <p>METHODS: Sixty-four cases(85 eyes)with senile lower entropion were divided into Group A(31 cases 42 eyes)and Group B(33 cases 43 eyes)according to the different ways of operation from January 2013 to October 2014 in our hospital. Patients in Group A were treated by eyelid retractor muscle transposition while patients in Group B treated by eyelid orbicularis muscle folding shortening combined with lower eyelid retractor muscle transposition. The short-term and long-term therapeutic efficacy and two-year recurrence rates after operation were compared between the two groups. <p>RESULTS: The short-term effective rate of patients in Group B was higher than that of Group A while the difference was not statistically significant(98% <i>vs</i> 95%, <i>P</i>>0.05). The long-term effective rate of patients in Group B was higher than that of Group A and the difference was statistically significant(95% <i>vs </i>83%)and two-year recurrence rate of patients in Group B was lower than that of Group A(5% <i>vs</i> 17%)and the difference was statistically significant(<i>P</i><0.05). <p>CONCLUSION:The clinical curative effect of eyelid orbicularis muscle folding shortening combined with lower eyelid retractor muscle transposition is better than single retractor muscle transposition in the treatment of senile lower eyelid entropion.

Treatment efficacy of lower eyelid twitch shift joint outer canthal ligament shortening surgery in degenerative analysis / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To observe and compare efficacy of the lower eyelid twitch shift joint outer canthal ligament shortening surgery and orbicularis muscle resection surgery to treat degenerative entropion. METHODS: Patients with degenerative entropion in our hospital were selected. The test group was 40 cases ( 70 eyes), of which double eyes with attack (30 cases), and lower eyelid twitch shift joint outer canthal ligament shortening surgery was applied to the test group. Control group was 20 cases (26 eyes), of which double eyes with attack ( 6 cases ) , and the control group was used by orbicularis muscle resection surgery. The correction rate, double eyelid symmetry and overcorrection rate were observed in two groups at postoperative 1wk. The long-term recurrence rate, double eyelid symmetry and overcorrection rate with follow-up 6mo were observed. RESULTS: After 1wk, the correction rate of experimental group 98. 6%, undercorrection rate of that was 1. 4%, all the eyelid was symmetry, only one eye with a slight overcorrection. Correction rate of control group was 92. 3%; all the eyelid was symmetry, and the poor rate of this group was 7. 7%. After 6mo, correction rate of experimental group was 95. 2%; undercorrection rate of experimental group was 3. 2%, and overcorrection rate was 1. 6%. Correction rate of control group was 87%, and 2 eyes of recurrence, 1 eye with a poor overcorrection. Double eyelid was symmetry, overcorrection rate difference was not statistically significant ( P > 0. 05 ), and the correction rate were significantly different (PCONCLUSION: Compared toorbicularis muscle resection surgery, postoperative recurrence rate of lower eyelid twitch shift joint outer canthal ligament shortening surgery is significantly lowered.

Treatment efficacy of eyelid twitch muscle transposition surgery in senile entropion / 国际眼科杂志(Guoji Yanke Zazhi)

AlM:To explore treatment efficacy of the lower eyelid twitch muscle transposition surgery in senile entropion.METHODS:Fifty cases (86 eyes) of senile lower eyelid entropion patients underwent lower eyelid twitch muscle transposition correction surgery as the experimental group, and the other 42 cases (68 eyes) of senile lower eyelid entropion patients received orbicularis muscle shortening correction as controls group. The correction rate, double eyelid symmetry and overcorrection rate of patients were observed one week after surgery. The patients were followed up for 6~12mo to be observed the long-term recurrence rate, double eyelid symmetry and overcorrection rate.RESULTS: One week after operation, eyelid symmetry, overcorrection rate of experimental group and control group had significant difference (P<0. 05); After followed up for 6 ~12mo, eyelid symmetry, overcorrection rate of experimental group and control group had significant difference (P<0. 05). CONCLUSlON: Folding and orbicularis muscle shortening treatment of senile entropion was compared with the lower eyelid twitch muscle transposition surgery treatment of senile entropion, We can find that clinical results in double eyelid surgery symmetry and overcorrection rate are of obvious advantage.

A Case of Nishida Muscle Transposition Procedure for Abducens Palsy

PURPOSE: Herein we report a successful Nishida muscle transposition procedure (modified Jensen procedure) with right medial rectus recession for treating a right abducens palsy patient. CASE SUMMARY: A 63-year-old male presented with a 30-year history of esotropia due to traumatic abducens palsy in his right eye. At initial examination, right eye visual acuity was 0.9 and intraocular pressure was 11 mm Hg. Ocular movement of the right eye was restricted in the lateral direction and prism cover-uncover test revealed 75 prism diopter right esotropia. For 2 years, the patient was treated as normal tension glaucoma and used his right eye as the dominant eye by turning his head due to glaucomatous field defect in the left eye. We performed 8.0 mm medial rectus recession and Nishida muscle transposition procedure in the right eye and inserted a suture through the temporal margin of each vertical rectus muscle. One week after surgery, the right eye maintained relatively straight alignment and prism cover-uncover test showed 20 prism diopter residual esotropia in the left eye. CONCLUSIONS: The Nishida muscle transposition is a simple procedure and prevents postoperative risk of anterior segment ischemia without the occurrence of tenotomy and muscle splitting. We report a successful Nishida muscle transposition procedure in a patient with chronic abducens palsy.

Clinical Manifestations and Surgical Outcomes of Double Elevator Palsy

PURPOSE: To evaluate the clinical manifestations of double elevator palsy and describe the surgery outcomes in patients. METHODS: We performed a retrospective chart review of all patients who were treated surgically for double elevator palsy between 1999 and 2012 at Yonsei University, Severance Hospital in Seoul, Korea. RESULTS: Overall, 15 subjects (7 males and 8 females) with a mean age of 14.6 years (range, 3-40 years) underwent their first surgery during the study period. All patients received inferior rectus recession as a primary procedure. Nine patients (60.0%) underwent a secondary procedure which included 4 cases of horizontal muscle transposition, 2 cases of correction of exotropia, and 3 cases of correction of hypotropia and exotropia simultaneously. The mean preoperative hypotropia was decreased from 29.9 +/- 8.4 prism diopter (PD) to 4.7 +/- 5.3 PD postoperatively. Mean follow-up period was 40.9 +/- 48.2 months. Seven patients (46.7%) underwent eyelid surgery for true ptosis. At last follow-up, a majority of patients showed mild or no amblyopia. CONCLUSIONS: Primary inferior rectus recession and additive secondary horizontal muscle transposition surgery was effective in treatment of double elevator palsy. The clinical manifestations and surgical outcomes of monocular elevation deficiency in the present study can help in the treatment of Korean patients.

Operación de Pickrell o graciloplastía no estimulada: ¿Tiene un rol en el manejo quirúrgico actual de la incontinencia anal severa? / Non stimulated gracilis muscle transposition for fecal incontinence: non stimulated graciloplasty (Pickrell's operation): does it play a role to day in the management of the severe anal incontinence?

Pickrell procedure or non stimulated gracilis muscle transposition is used for the management of severe fecal incontinence. We report four males and one female, aged 6 to 68 years, with severe incontinence, that were operated. Surgical complications were wound dehiscence in two patients, a deep venous thrombosis in one patient and chronic pain in the zone of muscle insertion in one patient. There was an improvement in the voluntary contraction pressure of the sphincter in four of five patients and a significant reduction in the incontinence score.

Se presenta la casuística de Operación de Pickrell o graciloplastía no estimulada realizada por uno de los autores (CJB). Se analizan sus indicaciones, técnica, complicaciones, manejo postoperatorio y resultados. Se presentan 5 pacientes (4 hombres y una mujer) operados por incontinencia anal severa, realizándose una graciloplastía no estimulada u operación de Pickrell. Las principales complicaciones fueron dehiscencia cutánea en 2 pacientes, trombosis venosa profunda y dolor crónico de la zona de desinserción en un caso. No hubo mortalidad. En el postoperatorio se envió a estimulación eléctrica del gracilis. Se evaluó la presión del esfínter con manometría anorrectal pre y postoperatoria. La incontinencia fue medida con la escala de Jorge y Wexner. En esta serie, hubo mejoría significativa de la Presión de Contracción Voluntaria y disminución significativa del puntaje de incontinencia. La graciloplastía es alternativa a una ostomía definitiva o al implante de un esfínter artificial en aquellos pacientes en que la incontinencia anal severa no es posible de manejar con técnicas habituales (esfinteroplastía), que fracasaron a la esfinteroplastía, o que presentan inexistencia de esfínter o de una lesión anatómica que reparar.

A Case of Surgical Repair For Convergent Strabismus Fixus with Bilateral Abducens Nerve Palsy

PURPOSE: We report a case in which a convergent strabismus fixus due to head trauma-induced bilateral abducens nerve palsy was successfully corrected. METHODS: A 45-year-old male patient who had bilateral,convergent strabismus fixus and limited eye movement because of bilateral abducens nerve palsy. A year previously, the patient had experienced a skull fracture and right facial nerve palsy caused by a traffic accident. At that time, the forced duction test revealed severe restriction of both eyes. The forced duction test still showed resistance after the right medial rectus muscle was disinserted. We made a conjunctival incision on the lateral canthal area and resected the right lateral rectus muscle. Then we performed lateral canthotomy, and fixed the lateral rectus muscle to the periosteum of the lateral orbital rim. When the left medial rectus muscle was disinserted, there was no resistance on the forced duction test. We then addressed the medial rectus muscle recession, superior and inferior rectus muscle transposition to the lateral rectus. RESULTS: Two years after the procedure, bilateral convergent strabismus fixus did not recur, even though right eyeball movement was impossible. Patient appeared an orthophoria at the primary position, and the cosmetic rersult was satisfactory.

A case report of reconstruction of facial paralyzed patient

The Frontalis Muscle Transposition in Severe Congenital Ptosis

The frontalis sling operation for the correction of severe congenital ptosis have been used, but this method is not entirely satisfactory in some cases due to longstanding lagophthalmos, lid lag, undercorrection. So authors have used the frontalis muscle transposition in 5 patient (6 eyes) in 1996 Febuary to July with satisfactory results. The frontalis sling operation was correction method by using foreign materials in severe ptosis patients with poor levator function, however, the operation method of frontalis transposition was correction method by using patients` own muscle, so more physiologic than frontalis sling operation. And postoperative compliscations including lagophthalmos, undercorrection were less developed in patients were operated by method of frontalis muscle transposition. Therefore, the frontalis muscle transposition need careful technique anatomically but more physiological operation method than frontalis sling operation in severe congenital ptosis patients with good frontalis muscle function.

Gluteus Maximus Transposition for Anal Incontinence

Anal incontinence following pelvic trauma, surgery or neurologic disorder has significant medical and social implications. When no known functioning sphincter muscles are present, surgical correction of this distressing condition other than by stomal fecal diversion is aimed at recreating a sphincter mechanism under voluntary control. The use of the gluteus maximus encircling the neorectum with a contractile muscualr ring provides an active control of continence and reserves the anorectal angulation. The sacrifice of the entire gluteus maximum muscle in an ambulatory patient will cause difficulty in climbing stairs; however, the use of the anatomically dissected lower half will preserve its function. With careful dissection, the lower half of the g1uteus maximus muscle together with its neurovascular supply can be developed for anal sphincter reconstruction. Three Patient, (two men and one woman) underwent g1uteus maximus transposition for complete anal incontinence. The indication for operation were sphincter destruction secondary to extensive soft tissue necrosis on perianal, perineal and buttock area due to necrotizing fascitis(n=2), and soft tissue defect on perianal, buttock area due to trauma(n=1). The procedure is performed with the use of a diverting colostomy. The inferior portion of the origin of each gluteus maximus is detached from the sacrum and coccyx, bifurcated,and tunneled subcutaneously to encircle the anus. The ends were sutured together to form two opposing slings of voluntary muscles. Postoperatively two patient regained continence to solid stool, one to liquid stool as well. The technique of constructing sphincter is simple and utilizes principles of muscle tendon transfer without jeopardizing function of gait. Furthermore the gluteus maximus muscle, being an accessory muscle of anal continence, is an ideal structure for this reconstruction.

A Clinical Report on the Use of Autogenous Levator Muscle Transposition and Bilateral Frontalis Sling for Ptotic lid in Neurogenic Blepharo-ptosis

The authors performed frontalis sling operation using autogenous levator muscle transposition for ptotic lid between February, 1989 and March, 1993. Four cases were Marcus-Gunn ptosis and one case was paralytic ptosis with aberrant regeneration in patient with oculomotor nerve palsy. The postoperative surgical results were satisfactory cosmetically.

Long-term follow-up of gracilis muscle transposition in children

Sixteen children of uncontrollable fecal incontinence have been treated with Pickrell's gracilis muscle transposition since 1983: 12 had an imperforate anuses with multiple corrective operative procedures and 4 had traumatic destructions of anal sphincters. We report a series of 11 cases whom we followed-up over a period of 0.8 to 10.5 years (mean; 5.6 years). Seven patients were evaluated by anorectal manometry. All patients except one who had left hemipelvectomy and permanent colostomy showed nearly normal continence during the follow-up period. There was no evidence of fibrosis in the transposed muscles and the tensions of the transposed muscles were well maintained. The voluntary contractions of the transposed muscles were well maintained and efficient in all cases. The general manometric parameters did not correlate well with the functional results; however, there was a strong correlation in the S/R ratio (maximum squeeze pressure/resting pressure) with the functional results. We believe that the good functional outcome of this procedure need not only the meticulous surgical technique but also the personal motivation and the compliance with physiotherapy. In conclusion, although the gracilis muscle transposition never results in normal continence, acceptable continence can be achieved in the selected patients.

Surgical Correction of Exotropia due to Oculomotor Nerve Palsy

In third nerve palsy, the functions in the four of the six extraocular muscles are compromised and its treatment is the most difficult problem in the paralytic strabismus. In surgical method, large recession and resection of horizontal rectus muscles, lateral rectus muscle transposition to medial rectus muscle and superior oblique muscle transposition are used for strabismus surgery on oculomotor nerve palsied eye. We compared the results of two methods of surgical correction. In three eyes, lateral muscle transpositions to medial rectus muscle were performed. On the last follow up examination (men; 6.7 months), two eyes resulted in severe hypertropia and unacceptable ocular alignment and no improvement of limited adduction. In six eyes of whom superior oblique muscle transpositions were performed, all resulted in acceptable ocular alignment, no hypertropia, and the limitations of adduction were improved markedly. Therefore, in the treatment of third nerve palsy, sperior oblique muscle transposition is more effective than lareral rectus muscle transposition to medial rectus muscle.

Strabismus Surgery on Congenital Oculomotor Nerve Palsied Eye

In congenital third nerve palsy, the function in four of the six extraocular muscles is compromised, and its treatment is the most difficult problem in paralytic strabismus. In general, either large recession and resection on horizontal rectus muscles or superior oblique muscle transposition is used for treatment. We compared the results of the two methods of surgical therapy. A Total of nine eyes in nine cases underwent surgical correction for ocular alignment in the primary position, In four eyes of four cases horizontal rectus muscle surgery was performed. In five eyes of five cases superior oblique muscle transposition was performed. Postoperatively, one of four cases who underwent horizontal rectus muscle surgery and four of five cases who underwent superior obique muscle transposition resulted in acceptable ocular alignment, in which the angle of deviation at the primary position was within 2 delta. Therefore, in the treatment of congenital third nerve palsy, superior oblique muscle transposition is more effective than horizontal rectus muscle surgery for the correction of ocular alignment.

Muscle Transpositon in the Treatment of Soft Tissue Defect of the Leg / 대한정형외과학회잡지

The management of chronic osteomelitis of the tibial diaphysis and certain post-traumatic defects of the lower extremity is extremely difficult. the diverse methods of treatment signify current dissatisfaction with any single method. Recently, the muscle transposition technique has gained an accepted place in treating wide soft tissue defect with bone exposure. Popularized by Ger, Vasconez, Pers, Mc Hugh and others, this technique is generally simple, safe, and reliable, The 21 patients who treated by muscle transposition at the Kyungpook National University Hospital between 1980 and 1987 were reported. The results were as follows :l. 19 patients were males and 2 were females. 2. The cause of lesion were 8 cases of open fracture, 10 cases of chronic osteomyelitis, chronic ulcer 1 case, malignent melanoma 1 case, burn scar contracture 1 case. 3. The muscles used for transposition according to lesion site of leg were as follows. Medial head of gastrocnemius was transposed in 2 case of knee and 4 cases of proximal 1/3 lesion, 11 cases of middle l/3 lesion was used soleus, 1 cases were gastrocnemius after soleus, 1 case was tibialis anterior, 2 cases of distal 1/3 were used each 1 case of solus, 1 case of F.H.L. 4. All cases were healed within 2 to 3 weeks after muscle transposition, and this technique seemd to afford favorable influence upon the healing of fracture and the eradication of infection.