Sequential Correction for Large Exotropia: A Case of Iatrogenic Exotropia Developed after Excision of Medial Rectus Muscle During Functional Endoscopic Sinus Surgery (FESS)

PURPOSE: To report a case of iatrogenic exotropia caused by accidental excision of medial rectus muscle during functional endoscopic sinus surgery (FESS), which was successfully corrected by sequential surgical intervention (superior and inferior rectus muscle transposition followed by lateral rectus muscle recession). CASE SUMMARY: Forty one year old male patient visited our clinic with large exotropia of the right eye developed after functional endoscopic sinus surgery (FESS) which was performed one year ago. At the initial visit in our clinic, there was a large exotropia (95 PD) of the right eye and transection of the medial rectus muscle was observed at the orbital MRI. In order to correct this large iatrogenic exotropia, sequential surgery was planned. Initially, full-tendon transposition of the right superior and inferior rectus muscle was performed which reduced the deviation to 35 PD. Six weeks after the initial surgery, 7 mm right lateral rectus muscle recession was additionally performed, which resulted in exotropia of 10 PD. Diplopia was also improved and the patient was esthetically satisfied with the result. CONCLUSIONS: Even in a case of iatrogenic exotropia following one year after an accidental excision of medial rectus muscle during intranasal sinus surgery, sequential surgery such as transposition of superior and inferior rectus muscle followed by lateral rectus muscle recession can result in satisfying cosmetic and functional improvement.

Full Tendon Transposition Augmented with Posterior Intermuscular Suture and Recession-Resection Surgery

PURPOSE: To report an effect of the full tendon transposition augmented with posterior intermuscular suture and recession-resection surgery, for the patient with monocular elevation deficiency (MED) and large exotropia. METHODS: Interventional case report. Full tendon transposition augmented with posterior intermuscular suture and recession-resection surgery was performed for a 26-year-old male patient had monocular elevation deficiency (MED) and large exotropia. RESULTS: Preoperative angle of deviation was 56 prism diopters (PD) hypotropia and 45 PD right exotropia, compared with 18 PD left hypertropia and 10 PD right esotropia postoperatively. Essotropia persisted after 2.5 years, however, and so the right medial rectus was recessed after removal of the previous posterior intermuscular suture. At a three-year follow-up after the second surgery, alignment was straight in the primary position at near and far distances. CONCLUSIONS: Full tendon transposition augmented with posterior intermuscular suture and recession-resection surgery was effective for a patient with MED associated with significant horizontal deviation, and a second operation was easily performed when overcorrection occurred.

The Result of Full Tendon Transposition in Paralyzed Strabismus

Nine patient with paralyzed strabismus of large deviation(Seven patients with lateral rectus or medial rectus muscle palsy and two patients with double elevator palsy) had full tendon transposition procedure. If remained strabismus was large postoperatively, recession of anatagonist of paralyzed muscle and botulinum toxin infection was performed respectively. Five patients achieved single binocular vision within central 10 degree of visual field. And six patients achieved less than 10 prism diopter of deviation in primary position. Our method compares favorably with previously descrived transposition procedure for muscle palsy in terms of the amount of correction and the extent of the window of single binocular vision with low risk of anterior ischemia syndrome.