Effect analysis of partial transposition of vertical rectus combined with medial rectus recession under microscope on treatment of complete abducens nerve palsy esotropia / 上海交通大学学报（医学版）

Objective: To investigate the clinical effect of partial transposition of the vertical rectus combined with medial rectus recession on the treatment of abducens nerve palsy esotropia under the microscope. Methods: Nine patients with abducens nerve palsy esotropia were treated in Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine from March 2015 to June 2017. The strabismus surgery was performed under the microscope, with partial transposition of the vertical rectus combined with medial rectus recession. Postoperative follow-up was performed to observe the effect. Results: After 1 week, 7 patients’ primary position were orthotopic(within ±10Δ), and 2 patients were undercorrection (+15Δ and +20Δ). Abduction function of all the patients improved significantly. The eyes could cross the midline. After 1 month, 6 patients’ primary position were orthotopic (within ±10Δ), 3 patients were undercorrection(respectively +15Δ, +15Δ and + 30Δ). After 1 year, 5 patients’ primary position were almost orthotropia (within ±10Δ), and 4 patients were undercorrection (respectively +15Δ, +15Δ, +30Δ and +40Δ). Conclusion: Partial transposition of the vertical rectus combined with medial rectus recession under the microscope is a safe and effective surgical method in treatment of complete abducens nerve palsy esotropia. It can not only improve the ocular position, but also effectively improve the abduction function of the paralytic eye. However, it is easy to be undercorrection in the long-term.

Vertical rectus transposition procedures for lateral rectus palsy: A systematic review

Multiple transposition procedures have been described for management of lateral rectus palsy. However, relative effect and indications of each procedure are unclear. This systematic review was planned to evaluate functional and anatomical outcomes of vertical rectus transposition (VRT) surgery in patients with lateral rectus palsy. We searched databases in English language, namely, MEDLINE, PubMed Central, EMBASE, Google Scholar, Scopus, and Index Copernicus without any date restrictions in electronic searches, using the search words 'vertical rectus transposition for lateral rectus palsy,” “vertical rectus transposition for abducens palsy,” “superior rectus transposition,” “inferior rectus transposition,” and “Hummelsheim procedure.” References of the selected publications were also searched to find any relevant studies. We searched for studies that provided data on single VRT and double VRT surgeries for lateral rectus palsies. Three authors independently assessed the related studies gathered from electronic and manual searches. We found 27 studies which were relevant to the review question. As there were no randomized control trials (RCTs) available related to our study question, nonrandomized studies were used to arrive at summarization of outcomes of different transposition procedures. There is a need for prospective RCTs to investigate the different types of transposition procedures for lateral rectus palsy.

Spinopelvic Reconstruction with Femoral Allograft and Vertical Rectus Abdominis Myocutaneous Flap after Total Sacrectomy in Recurrent Sacral Chordoma: A Case Report

STUDY DESIGN: Case report. OBJECTIVES: To report a case of recurrent sacral chordoma treated with total sacrectomy and spinopelvic reconstruction. SUMMARY OF LITERATURE REVIEW: Sacral chordoma is a musculoskeletal tumor reported to have a low incidence. Surgical treatment is considered difficult due to the complicated sacropelvic structure, so the prognosis for patients with sacral chordoma has been considered poor. MATERIALS AND METHODS: We report a surgical technique and outcomes from spinopelvic reconstruction with femoral allograft and vertical rectus abdominis myocutaneous flap after total sacrectomy. RESULTS: We report no tumor recurrence at 43 months postoperatively. CONCLUSIONS: Spinopelvic reconstruction with thorough surgical planning after total sacrectomy was found to be a safe and effective treatment method.

Resección abdominoperineal isquioanal con reconstrucción de pared posterior de vagina con colgajo miocutáneo de músculo recto abdominal vertical / Ischioanal abdominoperineal resection with reconstruction of posterior wall of vagina with vertical rectus abdominis myocutaneous flap

El colgajo del recto abdominal miocutáneo vertical, es un excelente colgajo que rellena el gran defecto en la pelvis luego de una resección abdominoperineal isquioanal, siendo libre de tensión y reduciendo significativamente la incidencia de complicaciones de la herida perineal y la estancia hospitalaria, con el cual se puede reconstruir la pared posterior de la vagina. Se reporta aquí el primer caso en Costa Rica de una resección abdominoperineal isquioanal, con reconstrucción de pared posterior de vagina con colgajo del recto abdominal miocutáneo vertical, practicada con éxito en una paciente de 62 años, con un adenocarcinoma rectal localmente avanzado con infiltración de pared posterior de vagina.

Vertical rectus abdominis myocutaneous flap, is an excellent flap that fills the large defect in the pelvis after an adominoperineal ischioanal resection; it is free from tension, significantly reduces the incidence of perineal wound complications and hospital stay and can be used to reconstruct the posterior wall of the vagina. We report the first case of Costa Rica abdominoperineal ischioanal resection with reconstruction of posterior vaginal wall with vertical rectus abdominis myocutaneous flap, successfully practiced in a patient of 62 years with locally advanced rectal adenocarcinoma infiltrating posterior wall of the vagina.

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.

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 40delta XT. Two patients with 70delta and 85delta XT underwent an X-type augmented Hummelsheim 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 Hummelsheim procedure showed a residual XT of 25delta. 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 Hummelsheim procedure coupled with an ipsilateral LR recession had an augmenting effect.

Graded Partial Tenotomy of Vertical Rectus Muscles for Treatment of Hypertropia

PURPOSE: To evaluate the effectiveness of graded (adjustable intraoperatively) partial vertical rectus muscle tenotomy at the insertion in correcting small degrees of hypertropia. METHODS: All patients with best corrected visual acuity of better than 6/30 in both eyes who had undergone only partial tenotomy of vertical rectus muscle(s) over a 30-month period were included. Improvement was evaluated 6 weeks postoperatively as the change in alignment in prism diopters (PD) in primary gaze and in the field of action of the affected rectus muscle(s). Binocular function was evaluated by Titmus stereoacuity and the Worth 4-light tests. RESULTS: All 24 patients who met the inclusion criteria had diplopia preoperatively, and this had resolved in 17 (71%) postoperatively (P<0.005). Prisms were used by 6 preoperatively vs. 2 postoperatively (P<0.05). The average vertical deviation in primary gaze decreased from 8 PD to 2 PD (P<0.005). In the field of action of the treated rectus muscle, hypertropia decreased from an average of 8 PD to 3 PD (P<0.005). For the available pre- and post-operative assessments, stereoacuity improved after 10 of the 18 (56%) procedures and Worth 4-light testing showed improvement or maintenance of fusion after 13 of 19 procedures (68%). CONCLUSIONS: Graded vertical rectus partial tenotomy can effectively reduce small degrees of hypertropia and associated diplopia, improve binocular function, and reduce or eliminate the need for prism correction.

Operations on Vertical Rectus Muscles: Their Influence on Horizontal Strabismus

PURPOSE: To investigate the change of horizontal deviation after recession or resection of vertical rectus. METHODS: Retrospective analysis of patients who underwent recession or resection of the vertical rectus to correct vertical strabismus or dissociated vertical deviation from January 1997 to December 2001. RESULTS: Of 39 patients who underwent superior rectus recession, 14 showed exodeviation, 18 esodeviation and 7 no change compared to preoperative horizontal deviation. The mean change was 0.4 prism diopter esodeviation, which was not statistically significant(paired t-test, p=0.96). Nor was there any significant change of horizontal deviation after inferior rectus recession or resection(paired t-test, p=0.95). CONCLUSIONS: Recession or resection of the vertical rectus did not influence horizontal deviation significantly.

Persistent Diplopia after Local Anesthesia

PURPOSE: To determine causative factors of persistent diplopia after local anesthesia for ophthalmic surgery. METHODS: Prism and alternate cover test in the diagnostic positions of gaze and ductions/versions testing were performed in 26 patients with persistent diplopia six months after local anesthesia. Lancaster test, Bielshowsky head tilt test, double Maddox rod test, funduscopic examination for torsion, forced duction test, force generation test, tensilon test, thyroid function test, and/or orbit CT were done when necessary. RESULTS: Most of the patients (24 patients, 92%) did not have diplopia before local anesthesia. Of the thirteen patients with strabismus resulting from trauma to extraocular muscles, eleven patients showed vertical rectus overaction (10 superior recti, 1 inferior rectus) and two patients, mild vertical rectus underaction. Eight patients were presumed to have sensory deviation. In the remaining patients, one patient had childhood esotropia and another, old superior oblique palsy. Three patients showed a small vertical deviation without any specific cause. CONCLUSIONS: Fifty percent of diplopia was related with the surgical trauma to extraocular muscles, in which overactions (42%) were more common than underactions (8%). Thirty-five percent of the patients were presumed to have sensory deviation, which suggested the importance of preoperative examination for strabismus as well as the explanation about the risk of postoperative diplopia before surgery.

Two Cases of Correction of Excyclotorsion Remained after Harada-Ito Procedure

Authors performed horizontal transposition of superior and inferior rectus muscle in 3.0 mm, to eliminate excyclotorsion of the 5 degrees which remained after Harada-Ito procedure in two patients with superior oblique palsy. The medial and lateral edges of the proximal part of tendon were reattached at the temporally and the inferior retus nasally. This operation was performed 3 or 4 months ater Harada-Ito procedure in 2 patients, respectively. The amount of horizontal transposition was made according the degree of excyclotorsion measured by double maddox rod test. The results showed no cyclotorsion at head tilt to the right and double maddox rod test. In conclusion, the horizontal transposition of vertical rectus muscles is effective in the elimination of excyclotorsion remained after Harada-Ito procedure for superior oblique palsy.