Periosteal Fixation Applied to Patients with Large-angle Paralytic Strabismus

PURPOSE: To evaluate the effect of periosteal fixation in patients with large-angle paralytic strabismus that was not corrected through conventional strabismus surgery. METHODS: Four eyes of three patients with large-angle paralytic strabismus who underwent periosteal fixation from June 2014 to August 2014 were examined. All patients presented with exotropia > 50 prism diopters (PD). Two of them showed exotropia caused by chronic complete oculomotor nerve palsy; the other two showed exotropia caused by medial rectus muscle injury during endoscopic sinus surgery. RESULTS: The mean preoperative exodeviation using the Krimsky test was 58 ± 29 PD. The postoperative values were 6.5 ± 9.4 PD at 1 week, and 11.25 ± 2.5 PD at 6 months. The mean surgical effect of exodeviation was 43.75 ± 21.36 PD. CONCLUSIONS: Periosteal fixation is an effective surgery for the management of paralytic strabismus that was not corrected through conventional strabismus surgery.

Clinical Course and Prognostic Factors of Acquired Third, Fourth, and Sixth Cranial Nerve Palsy in Korean Patients

PURPOSE: This study aimed to evaluate the clinical course and prognostic factors of acquired third, fourth, and sixth cranial nerve (CN) palsy grouped according to etiology. METHODS: This study involved a retrospective review of the medical records of 153 patients who were diagnosed with acquired paralytic strabismus from January 2004 to July 2015. Outcomes, recovery rates, and time to recovery were investigated according to the affected CN: CN3, CN4, and CN6 palsies. The patients were classified into four groups based on etiology: idiopathic, traumatic, neoplastic, and vascular. RESULTS: The mean age of the patients was 59.8 ± 14.5 years and the mean follow-up period was 10.8 months. Out of the 153 patients, 63 (41.2%) had CN3 palsy, 35 (22.9%) had CN4 palsy, and 55 (35.9%) had CN6 palsy. The most common causes were vascular related (54.9%), followed by idiopathic (28.1%), trauma (8.5%), and neoplasm (5.88%). About 50% of the patients recovered within six months. Among the four etiologic groups, the idiopathic group showed the best prognosis because about 50% of the patients in this group recovered within three months. This was followed by the vascular, traumatic, and neoplastic groups. Cox proportional hazard analysis revealed a significant association between the baseline prism diopter and recovery rate. CONCLUSIONS: The prognosis and natural history of paralytic strabismus vary depending on its cause. The vascular group had the best recovery rate and shortest recovery time, whereas the neoplastic group required the longest time to recover.

Clinical Features of Acquired Paralytic Strabismus

PURPOSE: The purpose of our study was to evaluate the cause of acquired third, fourth, and sixth nerve palsy while also establishing recovery rates and important factors for recovery. METHODS: A retrospective chart review was performed for 92 patients who visited the ophthalmologic department of Konyang University Hospital with acquired third, fourth, and sixth nerve palsy from March 2015 to February 2016. Recovery rates and factors for recovery were evaluated in only 66 patients who received first ocular exam within 2 weeks of onset and who were followed up for at least 6 months. Complete recovery was defined as both complete recovery of the angle of deviation and the restoration of eye movement in all directions. For the degree of ocular motor restriction, −4 was defined as not crossing the midline and −2 was defined as 50% eye movement. The degree of ocular motor restriction was analyzed from −1/2 to 4. RESULTS: The fourth nerve was affected most frequently (n = 37, 40.2%), followed by the sixth cranial nerve (n = 33, 35.9%), the third cranial nerve (n = 18, 19.6%), and a combination of 2 or more cranial nerves (n = 4, 4.3%). Vasculopathy (n = 44, 47.8%) was the most common etiology, followed by trauma (n = 14, 15.2%), idiopathic (n = 13, 14.1%), inflammation(n = 10, 10.9%), neoplasm (n = 9, 9.8%), and aneurysm (n = 2, 2.2%). Complete recovery rate occurred for 66.7% (n = 44) of patients, and the overall recovery rate (i.e., at least partial recovery) was 86.3% (n = 57). Significant factors for complete recovery were the initial deviation angle and the limitation of extraocular movement (p < 0.001, p = 0.005, respectively, according to univariate analysis). CONCLUSIONS: In this study, paralytic strabismus due to vasculopathy was the most common etiology, and a lower degree of initial deviation resulted in an improved complete recovery rate. In addition, a high overall recovery rate was possible through quick diagnosis and early treatment of cranial nerve palsy.

Clinical Observation on Acupuncture Combined with Western Medicine in Treating Acquired Paralytic Strabismus / 中医杂志

Objective To observe clinical curative effect of acupuncture combined with western medicine in treating acquired paralytic strabismus.Methods Randomly divided 60 patients with acquired paralytic strabismus into a treatment group and a control group,with 30 cases in each group.The control group accepted compound anisodine injection for subcutaneous injection beside superficial temporal artery and oral administration of neurotrophic drugs.The treatment group accepted acupuncture treatment in addition to the treatment of the control group.Both groups were treated for 4 weeks.Before and after treatment,measured the ocular symptom scores,including eye position deviation,eyeball movement obstacle,diplopia,the first squint angle being greater than the second,compensatory head posture and evaluated the clinical curative effect.Results The clinical curative rate in the treatment group was 40.0％ and the total effective rate was 93.4％,which in the control group were 10.0％ and 66.7％ respectively.The total effective rate and curative rate in the treatment group were significantly higher than those in the control group (P＜ 0.05).After treatment,the improvement in the total ocular symptom score and diplopia,deviation of eye position,eyeball movement disorder scores were superior to those in the control group (P ＜ 0.05).Conclusion Acupuncture combined with western medicine was superior to simple western medicine in treating acquired paralytic strabismus,and could significantly improve the eye symptom.

Two Cases of Extraocular Muscle Enlargement Caused by Metastatic Cancer

PURPOSE: To report two cases of extraocular muscle enlargement due to malignant cancer metastasis. CASE SUMMARY: A 56-year-old woman presented with horizontal diplopia first noted 1 month earlier. She had a history of small cell lung cancer with brain and bone metastases. She had a -3 abduction deficit in the right eye and esotropia. The forced duction test showed no limitation in horizontal movement. Antibody tests for thyroid disease showed normal results. Brain magnetic resonance image showed multiple nodular enlargements of the right lateral and medial rectus muscles, al so multiple metastatic nodules in the brain. A 38-year-old woman presented with horizontal diplopia first noted 3 months previously. She had undergone breast cancer surgery 6 months earlier. The patient had a -4 abduction deficit in the left eye and esotropia. The forced duction test showed no limitation in horizontal movement. Antibody tests for thyroid disease showed normal results. Orbital magnetic resonance imaging showed nodular enlargement of left lateral rectus muscle including a tendon. CONCLUSIONS: Extraocular muscle metastasis is a possible cause of extraocular enlargement and paralytic strabismus. In a patient with malignant cancer, the physician should consider the possibility of extraocular muscle metastasis and perform imaging for early diagnosis and treatment.

Clinical effect of compound anisodine on patients with paralytic strabismus and the influence on malondialdehyde and superoxide dismutase / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the clinical effect of compound anisodine on patients with paralytic strabismus and the influence on malondialdehyde ( MDA ) and superoxide dismutase ( SOD) . ●METHODS: Seventy cases diagnosed with paralytic strabismus from Jun. 2008 to Dec. 2014 were selected as treatment group; another 70 cases with paralytic strabismus from Oct. 2000 to Jan. 2008 were chosen as control group. The control group was given with conventional therapy, and treatment group was additionally injected with compound anisodine subcutaneously on the basis of the control group. Treatment lasted for two courses about 28days. The effect of compound anisodine on patients with paralytic strabismus was evaluated and the serum level of MDA and SOD was also measured before and after treatment. ●RESULTS: ln treatment group, 54 cases were cured (77%), 14 cases improved (20%) and 2 cases had no response ( 3%) and total efficiency reached to 97%. ln control group, 32 cases were cured ( 46%) , 21 cases improved ( 30%) and 17 cases had no response ( 24%) and total efficiency was 76%. The cure rate and total efficiency of treatment group were significantly higher than that of control group (P ●CONCLUSION: The compound anisodine shows the beneficial effect on patients with paralytic strabismus. Compound anisodine may exert the effect via increasing SOD and reducing MDA.

Tratamiento del estrabismo paralítico con toxina botulínica A / Treatment of paralytic strabismus with botulinum toxin A

Objetivos: evaluar los resultados obtenidos con el uso de la toxina botulínica A en la corrección del estrabismo paralítico e identificar los factores asociados que influyen sobre la respuesta terapéutica. Métodos: se realizó un estudio descriptivo en una serie de 93 casos con estrabismo paralítico, que recibieron tratamiento con toxina botulínica A. Resultados: se diagnosticaron 53 casos con estrabismo leve, 38 moderado y solo dos en estado grave. El tiempo de evolución y la gravedad clínica fueron los factores asociados que interfirieron con la respuesta terapéutica. Conclusiones: la toxina botulínica A es efectiva en la mayoría de los casos tratados. Los mejores resultados se obtienen en los casos con menor grado de desviación y con menor tiempo de evolución entre el inicio del estrabismo y la inyección del medicamento(AU)

Objectives: to assess the results of the use of botulinum toxin A in correcting paralytic strabismus and to identify those associated factors that have an impact on the therapeutic response. Methods: a descriptive study of a series of 93 cases with paralytic strabismus which were treated with botulinum toxin A. Results: fifty three cases were diagnosed with mild, 38 with moderate and just two with severe strabismus. The time of progression and the clinical severity were related factors that influence the therapeutic response. Conclusions: botulinum toxin A is effective in most of cases. The best results are achieved in those people with lower deviation degree and less time of progression elapsed from the onset of strabismus to the administration of the injected medication(AU)

EtioIogy anaIysis and surgery of paraIytic strabismus in aduIts / 国际眼科杂志(Guoji Yanke Zazhi)

·AlM: To investigate pathogeny and effects of surgery on paralytic strabismus. · METHODS: A retrospective study was done in 46 patients with paralytic strabismus who underwent squint correction in our hospital from June 2010 to June 2013. Among 26 horizontal strabismus, the cases of extra rectus palsy was 16, internal rectus palsy was 10.Among all20 vertical strabismus, the cases of superior oblique palsy, superior rectus palsy, inferior rectus palsy, double elevator palsy counted for 7, 8, 2 and 3, respectively. Pathogenesis: trauma was 19 cases, followed by 10 cases that the causes could not be identified.Nine was congen ital paralytic strabismus, 8 o ccurred after nose or brain surgery. The surgery methods included rectus muscle recession, rectus muscle resection, partial rectus muscle transposition, Jensen procedure, inferior oblique myectomy and anterior transposition of inferior oblique. Statistical software SPSS10.0 was used in chi-square test between two groups, while the situation of paralysis eye movements improved by two methods in the horizontal strabismus group was compared with t test. · RESULTS: Among all horizontal strabismus the rate of cure, improvement and inefficiency was 20 ( 77%) , 5 ( 19%) and 1 ( 4%) , respectively. Among vertical strabismus the ratio of cure, improvement and inefficiency was 15 (75%), 3 (15%) and 2 (10%).There was no significantly difference between the two groups ( P >0.05 ). The movements of paralytic eyes were improved. Two procedures used in horizontal strabismus, can improve paralysis eye movements were 3.76 ±0.91, 3.72 ±0.84mm, with no significant difference (P=0.93) statistically. · CONCLUSlON: Paralytic strabismus in adults had complicated conditions. Choosing different operation methods in treating paralytic strabismus according to the degree of paralysis can result in satisfactory cosmetically alignment of the eyes and modify head position and diplopia.

Clinical Features and Natural Course of Superior Oblique Palsy

PURPOSE: To evaluate the natural course of superior oblique palsy (SOP) with objective criteria, and to show the contemporary etiology and recovery rates among several factors. The clinical features of SOP were compared to previous studies. METHODS: A retrospective chart review of 80 patients diagnosed with SOP between January 1, 2006 and December 31, 2011 was performed. RESULTS: Clinical SOP features showed variation when compared to previous studies. Out of 80 patients, 71 were identified with unilateral isolated and 9 bilateral cases of SOP. Twenty cases were congenital and 60 cases were acquired SOPs. Acquired SOPs were affected most commonly by trauma (31%) and vascular disease (30%). Twenty-four out of 49 patients, who were followed up over 2 months after the first visit recovered, especially vascular origin cases, which was statistically significant (75%, p = 0.000). Patients with initial vertical deviation smaller than 5 Prism diopters (PD) experienced a more successful recovery than patients with an initial deviation larger than 5 PD. CONCLUSIONS: SOP has different recovery rates depending on the etiology. Accurate ocular examination and understanding of SOP etiology are necessary for successful treatment.

Recession-Resection Surgery Augmented with Botulinum Toxin A Chemodenervation for Paralytic Horizontal Strabismus

In this case series study, we assessed the effects of recession-resection surgery augmented with botulinum toxin A chemodenervation for patients with chronic paralytic horizontal strabismus. In addition, we compared these effects with those of full tendon transposition (FTT) augmented with posterior intermuscular suture (PIMS). Ten patients who underwent strabismus surgery due to paralytic horizontal strabismus were retrospectively reviewed. They received a recession-resection surgery augmented with botulinum toxin A chemodenervation (type I surgery) or a FTT augmented with PIMS (type II surgery). The preoperative angle of deviation (AOD) and postoperative improvement in AOD were compared according to the type of procedure. The preoperative AOD was 60.00 +/- 28.50 prism diopters (PD) for type I surgery and 68.00 +/- 27.06 PD for type II (p = 0.421). Improvement in AOD was 53.20 +/- 25.01 PD for type I surgery and 44.20 +/- 18.74 PD for type II (p = 0.548). Recession-resection surgery augmented with botulinum toxin A chemodenervation is a concise and effective procedure for treating paralytic horizontal strabismus.

Treatment of 42 cases of paralytic strabismus with self-designed Zhengrong decoction combined with acupuncture / 国际中医中药杂志

Objective To observe clinical effect of treating paralytic strabismus with self-designed Zhengrong decoction combined with acupuncture. Methods 42 patients with paralytic strabismus were randomly recruited into two groups. The control group was treated with vitamin B1 100 mg, vitamin B12 0.5 mg by intramuscular injection, energy mixture by intravenous drip, once daily. Ten days constituted a course and seven days served as a treating interval between two courses. The treatment group was treated with self-designed Zhengrong decoction combined with acupuncture based on the control group. The clinical effect was observed for both groups after the treatment. Results The total effective rate of the treatment group and the control group was 90.5% and 71.4% respectively. The clinical effect in the treatment group was significantly higher than that of the control group (χ2=4.021, P＜0.05) . Conclusion Self-designed Zhengrong decoction combined with acupuncture was more effective on paralytic strabismus than western medicine.

Results of Surgical Treatment for Paralytic Strabismus

PURPOSE: To study the correction effects of standard recession and resection in paralytic strabismus excluding superior oblique palsy. METHODS: Eighteen cases of paralytic strabismus treated by standard recession and resection from March 2005 to October 2007 were retrospectively analyzed. RESULTS: The average angles of deviation before surgery and after surgery were 55 prism diopters (PD) and 12PD, respectively. Adjustable suturing was performed in 12 cases. The diplopia was improved in 14 out of 18 cases (77%) after surgery. Three cases of the -4 grade paralyzed group had a large residual deviation after surgery. The success rate was 78% (14/18) when success was defined as a residual deviation of less than 15PD. Severe ocular motility limitation (-4 grade) group was less affected than other groups. In the below -3 grade paralyzed groups, patients resolved diplopia in the primary eye position, and did not complain of diplopia by incomitance in the secondary eye position. CONCLUSIONS: Standard recession and resection may actively be attempted in below -3 grade paralytic strabismus patients to resolve diplopia in the primary eye position.

Anticholinesterase Treatment for Patients With Paralytic Strabismus Following a Viper Bite

PURPOSE: To describe the therapeutic effect of anticholinesterase treatment for patients with paralytic strabismus and blepharoptosis following a viper bite METHODS: A prospective non-comparative interventional case series study was designed including 6 patients with ophthalmic complications such as paralytic strabismus and blepharoptosis following a viper bite. Anticholinesterase (pyridostigmine) 60 mg was administered to patients 3 times a day in additional to conservative treatment including antivenom, antibiotics and tetanus toxoid. Patients underwent a measurement of deviation, diplopia test and MRD 1. Subjective evaluation of the diplopia symptoms was performed daily after treatment. RESULTS: Subjective diplopia was relieved in 2 out of the 6 patients on the first day and in the other 4 patients on the second day. The angle of deviation decreased approximately 37% on the first day and ocular position became orthophoric on the third day in all patients. The blepharoptosis was completely resolved in 4 patients on the first day. No complication following anticholinesterase treatment was noticed. CONCLUSIONS: Treatment using anticholinesterase for patients suffering from diplopia and blepharoptosis following a viper bite is an effective and safe treatment.

A Clinical Study of Acquired Paralytic Strabismus in a Secondary Hospital

PURPOSE: To analyze the clinical course of acquired third, fourth, and sixth cranial nerve palsy at a secondary hospital. METHODS: We analyzed the medical records of 26 patients, 28 eyes who were diagnosed third, fourth, and sixth nerve palsy from March 2004 to September 2005. The clinical courses, affected cranial nerves, etiologic factors and recovery rates were examined retrospectively. RESULTS: The sixth cranial nerve was affected most frequently (12 eyes, 49.2%), followed by the third nerve (11 eyes, 17.9%). Vascular etiologic factors was most common (12 eyes, 42.9%). Only two cases were associated with neurosurgical diseases. Of the 28 eyes that were followed up for at least 3 months, 21 (75.0%) eyes showed a decrease in the angle of deviation. Of these, 14 (50%) eyes recovered completely. CONCLUSIONS: There are many vascular and undetermined etiologic causes of cranial nerve paralysis at 2nd grade hospital. So little cases are result from neurosurgical etiology. There are limitations in finding the affecting factors. Further evaluations for the factors associated with increasing recovery rates were needed.

Síndrome de Parinaud asociado a otros estrabismos / Parinaud syndrome associated with other strabismus

Objetivo: Describir los estrabismo asociados al Síndrome de Parinaud (SP). Métodos: Se estudiaron pacientes con SP de 1998 a 2004 asociados a otros estrabismos. Resultados: Total 18 pacientes, 6 mujeres y 12 hombres. Edad: 28 años DE 22 (10; 1C 95 por ciento). Lesión al III nervio craneal en 15 pacientes (79 por ciento), II nervio: 8 pacientes (44.4 por ciento), VII nervio: 3 pacientes, hemiparesia: 3, lesión a IV nervio 2, parálisis bilateral de III nervio 2, nistagmus 2, Síndrome de foville 2, y síndrome de uno y medio 1 paciente. Causas: Accidente vascular cerebral 4, uno de ellos asociado a infarto agudo de miocardio, traumatismo cráneo-encefálico 3, tumor cerebral 6, neurocisticercosis 2. Se obtuvo ortoposición con toxina botulínica en 1.72 +/- 1.1 (0.65 IC 95) y cirugía en 9, mejoría espontánea 1. Conclusiones: Identificar el diagnóstico topográfico y pronóstico de la lesión cerebral asociada a SP es muy importante en el control y vigilancia del paciente así como para ofrecer una rehabilitación mas dirigida.

Objective: To describe the causes of Parinaud syndrome (PS) with diplopia to determine a topographic diagnosis and prognosis. Method: We studied patients with SP from January 1980 to January 2004; causes and treatment. We identified all strabismus associated to PS. Results: We included 18 patients with diplopia, 6 female and 12 male. Age: 28 years old, SD 22 (10; CI 95 percent). Related strabismus: III nerve palsy in 15 patients (79 percent), optical nerve damage in 8 (44.4 percent), VII nerve palsy in 3, IV nerve palsy 2, bilateral III nerve palsy 2, nystagmus 2, Foville syndrome 2, One and half syndrome 1. Causes: Tumor 6, brain stroke 4, cranial trauma 3, neurocisticercosis 2. Ortoposition with botulinum toxin treatment was obtained with 1.72 +/-1.1 (0.65; IC 95 percent) inyections. Surgery was done in 9 patients, only one patient had spontaneous resolution of diplopia and SP. Conclusions: To identify the topographic diagnosis and prognosis of brain diseases in PS is very important to complete the study of strabismus. In this way we can know more about of damage extension and we can identify recurrences quickly to offer a better control.

Utilidad de la anestesia tópica en cirugía de estrabismo paralítico / Utility of topical anesthesia in paralytic strabismus surgery

Objetivo: demostrar el uso de anestesia tópica en cirugía de estrabismo paralítico. Método: Es un estudio retrospectivo, comparativo con dos grupos de pacientes mayores de 12 años de edad con estrabismos de diferentes etiologías. Grupo A: pacientes con estrabismo para corregirse bajo anestesia tópica. Grupo B: pacientes con estrabismo para corregirse bajo anestesia general. Para el uso de anestesia tópica se empleó proparacaína en gotas y midazolam intravenoso. Resultados: en grupo A se incluyeron 31 pacientes con una edad 34.1 DE (desviación estándar) 11.3 años con rangos de 18 a 56 años. Desviación 28.4 DE 15.5 dioptrías prismáticas. La cirugía más realizada fue la corrección de estrabismos verticales, y la técnica más comúnmente usada fue cirugía de dos músculos prefiriendo para el reforzamiento el plegamiento muscular. El promedio de seguimiento fue de 9.06 DE 6.3 meses. Se obtuvieron buenos resultados en 25 pacientes, 3 regular, 3 malo. El diagnóstico de estrabismo paralítico se concluyó en 17 pacientes, 8 de III nervio; 5 de IV nervio, 4 de VI nervio. Las causas del estrabismo fueron: tumoral: 6, trauma craneal: 3, aneurisma cerebral: 1, ambliopía sensorial 1, uno por cirugía de región, uno por cirugía de estrabismo bajo técnica ajustable tardía con gran reforzamiento de recto medial, trauma ocular 3 con un músculo perdido recto inferior, y un músculo perdido recto medial, endotropia congénita 7. En el grupo B se ingresaron a estudio 30 pacientes. Edad: 31.9 D.E 15.1 años, con rangos de 12 a 64 años. La desviación fue de 37.83 DE 21.8 dioptrías prismáticas, el estrabismo más operado fue la exotropia antigua especialmente consecutiva a corrección de estrabismo infantil. Se operaron mayor cantidad de músculos. El seguimiento fue de 6.03 DE 7 meses.

Objective: to demostrate the efficacy of topical anesthesia in paralitic strabismus. Method: This is a retrospective and comparative study in patients older than 12 years old, with strabismus of different etiologies. Group A: strabismus corrected under topical anesthesia. Group B: strabismus corrected under general anesthesia. For topical anesthesia we used proparacain and mydazolam. Results: group A: 31 patients, age 34.1 +/- 11.3 years old , 18-56 range. Strabismus deviation: 28.4 +/- 15.5 diopters. Vertical strabismus was the most common surgery. Two muscles technique was the most frequently used, but using tacking preferable. Follow up: 9.06 +/- 6.3 month. We obtainer good results in 20 patients, regular 3, and bad 3. Paralysis was diagnosed in 17 patients, III nerve: 8, IV nerve: 4 causes: 6 tumor, 3 cerebral trauma, 1 cerebral aneurism, 1 sensorial amblyopic, 1 posterior to pterigion surgery. 1 secondary to adjustable surgery for strabismus, 3 ocular trauma with lost muscle, 7 congenital esotropia. We didn't have complications and conversion to general was no necessary. Gruop B: 30 patients average age: 31.9 +/- 15.1 years old. Strabismus: 37.83 +/- 21.8 diopters. The most operated strabismus were old exotropias especially after infantile esotropias. We made more muscles for same quantity of deviation. Follow up: 6.03 +/- 7 months. Results for surgery: good 26, regular 3, bad 1. Conclusions: we could see the preferences for using topical anesthesia in paralysis. Results were good and we could evaluate muscles action under surgery. We could evaluate the effect of recessions in inferior oblique for paralytic strabismus, and effect of tucking in superior oblique avoiding Brown iatrogenic syndrome.

Clinical Results of Modified Muscle Transposition Surgery

PURPOSE: To report the clinical experience and surgical results of modified transposition surgery, in which half-width tendons are isolated and sutured into the paralyzed extraocular muscle. METHODS: We retrospectively reviewed the medical records of 6 patients (7 eyes), who had undergone modified transposition surgery to correct severe limitation of eye movement from January 1996 to December 2001. First, we divided the half-width tendons of two rectus muscles adjacent to the paralyzed rectus muscle and disinserted the halves from the sclera. The two half-width tendons were positioned underneath of the scleral insertion of the paralyzed muscle, sutured together and then sutured to the paralyzed muscle. In the case of contracture of the antagonizing extraocular muscle, recession of the antagonist was performed. RESULTS: Five of the six patients showed deviation under 15 prism diopters at primary gaze at distance, while synergistic divergence recurred in the sixth patient. CONCLUSIONS: Modified transposition surgery as described in this paper is thought to be an effective and safe method for correction of paralytic strabismus.

Thirty-eight Cases of Acquired Paralytic Strabismus Treated by Integrated Chinese and Western Medicine / 中华中医药杂志

Objective: To observe the clinical effect of integrated Chinese and Western medicine in the treatment of acquired paralytic strabismus. Methods:76 cases of acquired paralytic strabismus patients were randomly divided into control group and treatment group, 38 cases in each group. The control group was treated with ligustrazine HCl-iontophoresis in combination of Western medicine. Based on the therapy of the treatment group, the control group were treated with acupuncture. Results: The total effect of the treatment group was 94.74% (36/38), while the control group 81.58% (31/38). There was significant difference in statistics(P

The Effect of Botulinum Toxin Chemodenervation in Chronic Paralytic Strabismus

Botulinum toxin chemodenervation is widely used for the treatment of acute paralytic strabismus. We reviewed the effect of botulinum toxin chemodenervation for the treatment of chronic paralytic strabismus. Between 1996 and 1998, 13 patients with chronic paralytic strabismus were treated with botulinum toxin chemodenervation. The palsy of extraocular muscle persisted for at least 6 months. Each patient received an injection of 1.25 to 5 units of botulinum toxin[Botox]to the antagonist muscle of the paralytic muscle and two patients received injections two times. The follow-up was more than 6 months [mean 7.62 months].2 patients were treated with surgery of horizontal muscles and 3 patients were treated with muscle transposition surgery before injection. The mean preinjection deviation was 36.7PD and the mean strabismus angle after injection was 19.2PD and improving rate of the strabisbismus angle was 47.6%. The final deviations of 6 patients were within 10PD[46.2%]and 4 of 7 patients with final deviation above 10PD were treated with surgery later. Ptosis occurred in 4 patients[30.8%]and hypertropia occurred in 4 patients[30.8%]. In addition to the prevention of muscle contracture with botulinum toxin injection, it is likely that the therapeutic effect of botulinum toxin is produced by permanent alteration in the muscle and influence on the peripheral and central nervous system. Therefore botulinum toxin chemodenervation can be considered as a primary therapy or a subsequent therapy of surgery for chronic paralytic strabismus and further study is needed.

Preservation of Anterior Ciliary Vessels in Strabismus Surgery

Anterior segment ischemia syndrome is caused by disruption of anterior ciliary vessels at surgery on multiple rectus muscles in strabismus. Staging surgery has been recommended when more than 3 rectus muscles are to be tenotomized. The purpose of this study is to prevent anterior segment ischemia syndrome using the technique of anterior ciliary vessels under the surgical microscope, and correct paralytic and complicated strabismus at one surgery. Six patients underwent preservation of anterior ciliary vessels. Five patients had sixth nerve palsy in one eye. First, superior and inferior rectus muscles were transposed, then medial rectus was recessed with preservation of anterior ciliary vessels. Four were successful, but one was failed and needed second operation. Another patient showed exotropia and hypetropia of amblyopic eye, in which recession of lateral rectus and resection of medial rectus, and recession of superior rectus with preservation of its anterior ciliary vessels were performed. All the patients showed orthoporia without anterior segment ischemia. This study suggests that the preservation of anterior ciliary vessels of rectus muscles is a very delicate and time-consuming procedure, but effective in preventing anteior segment ischemia syndrome and reducing the number of surgery.