RESUMO
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.
RESUMO
@#AIM: To describe the clinical features of congenital isolated inferior rectus(IR)palsy with compensatory head posture of facial rotation and to analyze the effect of surgical treatment.<p>METHODS: Fifteen patients with IR muscle palsy further presenting with abnormal compensatory head posture of facial rotation were retrospectively identified from May 2014 to July 2018. Changes in the degree of facial rotation in patients were evaluated using an orthopedic goniasmometer. Variations in vertical and horizontal deviations were measured through prism and alternate cover tests, and changes in cyclotropia of pre- and postoperation were assessed by objective evaluation of eye torsion with fundus photography. IR resection was the main surgical treatment.<p>RESULTS: Among the 15 patients, 13 who were subjected to IR muscle resection or IR muscle resection combined with superior rectus muscle recession showed good results after surgery. These results included improved underaction of IR, coordination of eye movement, disappearance of abnormal facial rotation of compensatory head position, and total correction of vertical and horizontal deviation and cyclodeviation. Furthermore, each 1 mm resection of IR can correct 1.54±0.93° incyclotropia. In the other two patients with small vertical deviation who were done by inferior oblique myectomy, the improvement in facial rotation was unsatisfied, and eye motion remained uncoordinated.<p>CONCLUSION: Congenital isolated IR muscle palsy characterized by compensatory head posture of facial rotation is the main compensatory head posture. The resection of IR is effective and perfect. Mild overcorrection and undercorrection do not influence curative effect.
RESUMO
We describe a patient with isolated inferior rectus palsy due to midbrain infarction. A 68-year-old-man developed vertical diplopia of sudden onset which was maximal with a right lower side gaze. Neurological examination revealed weakness of the right inferior rectus muscle. Magnetic resonance imaging of the brain showed a focal infarction in the dorsomedial portion of the right midbrain tegmentum. The sole involvement of fascicular fibers of the inferior rectus muscle in the midbrain was accountable as the cause of this isolated inferior rectus palsy. We think that this is a case supporting the three-dimensional model of somatotopic fascicular arrangement of oculomotor nerve in the midbrain.