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.

Evaluation of periosteal fixation of lateral rectus and partial VRT for cases of exotropic Duane retraction syndrome.

Purpose: The purpose of this study is to evaluate the lateral rectus periosteal fixation and partial vertical rectus transpositioning (VRT) as treatment modalities to correct exotropic Duane retraction syndrome (Exo‑DRS). Materials and Methods: Prospective interventional case study of cases of Exo‑DRS with limitation of adduction. A total of 13 patients were subdivided into two groups. Six patients underwent only lateral rectus periosteal fixation (group A) and seven patients also underwent partial VRT (group B). Assessment involved prism bar cover test, abduction and adduction range, extent of binocular single visual field and exophthalmometry. These tests were repeated at 1 week, 1 month and 3 months post‑operatively and data analyzed. Results: The pre‑operative mean values and ranges were 26.2 Δ (22‑35) exotropia for group A and −21.3 Δ (14‑30) exotropia for group B. The post‑operative mean and range was +0.6 Δ esotropia (+20 to −8) for group A and 8 Δ (−2 to −20) exotropia for group B. Mean grade of limitation of abduction changed from −3.8 to −3.6 versus −3.6 to −2.8 and mean grade of limitation of adduction changed from −1.9 to −0.7 versus −1.5 to −0.5 in the groups A and B respectively. Mean binocular single visual field changed from 14.7° to 23.3° in group A and 11.8° to 26.4° in the group B respectively. Conclusion: Lateral rectus periosteal fixation is an effective surgery to correct the exodeviation, anomalous head posture and improving adduction in Exo‑DRS and partial VRT in addition is effective in improving abduction and binocular single visual fields.

Fixation of the Eyeball to the Periosteum Over the Posterior Lacrimal Crest in Inveterate Exotropia

PURPOSE: To report the results obtained after fixation of the eyeball to the periosteum over the posterior lacrimal crest in 5 cases of inveterate exotropia. METHODS: From September 2011 to January 2013, 5 patients with inveterate exotropia and a history of surgery for exotropia underwent fixation of the eyeball to the periosteum over the posterior lacrimal crest. RESULTS: The mean preoperative exotropia of 35 +/- 10.61 PD changed to esotropia of 5.8 +/- 17.28 PD at the one week postoperative visit and exotropia of 13.2 +/- 11.34 PD at the final postoperative visit (mean, 6.05 months after surgery). At the final postoperative visit, 2 patients who had ocular adhesion due to trauma showed 25 PD exotropia. None of the patients showed injuries to the lacrimal system, but 2 patients showed conjunctival granuloma. CONCLUSIONS: Fixation of the eyeball to the periosteum over the posterior lacrimal crest is an effective approach for the management of inveterate exotropia, except in cases of exotropia combined with ocular adhesion.

Periosteal Fixation in Bilateral Total Third Nerve Palsy

PURPOSE: We present a new technique of anchoring the eyeball to the nasal periosteum with supramaximal recession of the lateral rectus muscle in one eye for exotropia management in bilateral total third nerve palsy combined with trochlear nerve palsy. CASE SUMMARY: A 38-year-old man presented with drooping of both upper lids and exodeviation of the left eye with a history of intraventricular hemorrhage 9 months previously. We noted bilateral ptosis, dilated pupils, right fixing eye, left face turn, and left exotropia over 100 prism diopters (PD) in the primary position with an inability to move both eyes together except abduction. He was diagnosed with bilateral total third nerve palsy and trochlear nerve palsy. We fixated the left globe (sclera anterior to the insertion of the medial rectus muscle) to the nasal periosteum including the medial palpebral ligament using a nonabsorbable suture. A large recession of the left lateral rectus muscle (14 mm) was also performed. Ocular alignment in the primary position was exotropia of 25PD and cosmetically satisfactory after 6 months of follow-up. CONCLUSION: Supramaximal recession of the lateral rectus muscle and periosteal fixation using nonabsorbable suture is an effective technique for the management of exotropia secondary to total third nerve palsy.

The Effect of Autologous Dermis-fixation to Orbital Periosteum in Superior Sulcus Deformity

PURPOSE: To evaluate the efficacy of autologus dermis-fixation on the orbital periosteum in patients with superior sulcus deformity. METHODS: From September 2005 to February 2007, an appropriate amount of a rolled autologus dermis was added to the site of superior sulcus deformity by means of fixation to the orbital periosteum via lid crease incision. Four patients had superior sulcus deformity after undergoing evisceration or other ocular surgeries. RESULTS: Superior sulcus deformities in all patients could be corrected satisfactorily with bilateral symmetry. During the follow-up period, no complications such as mechanical ptosis and recurrence of superior sulcus deformity were observed. CONCLUSIONS: The authors believe that autologus dermis-fixation to the orbital periosteum might be a useful method to correct superior sulcus deformity without disturbing movement of the upper eyelid. A study with a larger series of patients and longer follow-up period might be necessary in the future to obtain more information about autologous dermis-fixation to the periosteum in patients with superior sulcus deformity.

A Case of Nevus Sebaceus, Accompanied by Syringocystadenoma Papilliferum, a Basal Cell Carcinoma-like Tumor, Sebaceous Epithelioma, Apocrine Adenoma and Tumor of Follicular Infundibulum, with Repair by Subgaleal-periosteal Fixation / 대한피부과학회지

Nevus sebaceus is well-known for its potential to develop both benign and malignant neoplasms of epidermal and adnexal origin. We found 5 tumors including syringocystadenoma papilliferum, a basal cell carcinoma-like tumor, sebaceous epithelioma, a tumor of follicular infundibulum and apocrine adenoma within a single nevus sebaceus lesion in a 37-year-old man. This is a rarely reported case of a nevus sebaceus lesion containing a basal carcinoma-like, trichoblastoma-like skin tumor and tumors of follicular infundibulum. The lesion was treated by wide excision and repaired with subgaleal-periosteal fixation which resulted in good wound healing.