Miopexia retroecuatorial del músculo oblicuo inferior: un debilitamiento alternativo / Inferior oblique retro-equatorial myopexy: An alternative weakening

OBJETIVO: Describir una alternativa quirúrgica para tratar la hiperacción del oblicuo inferior y presentar los primeros resultados con dicha técnica. MATERIAL Y MÉTODOS: Un total de 6ojos consecutivos de 6 pacientes con hiperacción primaria o secundaria del oblicuo inferior se sometieron a una operación de miopexia retroecuatorial del oblicuo inferior bajo anestesia general. Los resultados primarios medidos fueron la desviación vertical postoperatoria en el campo de acción del músculo oblicuo inferior y las complicaciones quirúrgicas intraoperatorias y postoperatorias. Los resultados finales se evaluaron después de 6 meses de cirugía. RESULTADOS: La muestra de pacientes consistió en 3 niñas y 3 niños de entre 3 y 7 años. La media de la hiperacción del oblicuo inferior preoperatoria fue 34 ± 4,6°, equivalente a 3+. La hiperacción del oblicuo inferior se redujo en todos los pacientes, siendo la media de reducción de 28 ± 1,98° y la desviación postoperatoria media de 6 ± 2,84°. Cuatro de 6ojos obtuvieron un éxito total, y solo un caso quedó sin corregir. No se produjeron complicaciones intraoperatorias o postoperatorias. CONCLUSIÓN: La miopexia retroecuatorial del músculo oblicuo inferior es un enfoque quirúrgico alternativo para la hiperacción del oblicuo inferior. Es una técnica eficiente, segura y reversible que podría usarse en casos de hiperacción del oblicuo inferior entre 2+ y 3+

PURPOSE: To describe an alternative surgical approach to treat inferior oblique overaction and report the first results of this technique. MATERIALS AND METHODS: A total of 6 consecutive eyes of 6patients with primary or secondary inferior oblique overaction underwent inferior oblique retro-equatorial myopexy under general anaesthesia. The primary outcomes measured were the postoperative vertical deviation in the field of action of the inferior oblique muscle, and the intra- and postoperative surgical complications. Final results were evaluated at six-months after surgery. RESULTS: The patient population consisted of 3 girls and 3 boys aged between 4 and 7 years old. The mean preoperative inferior oblique overaction was 34° ± 4.6°, equivalent to 3+. Inferior oblique overaction was reduced in all patients with a mean reduction of 28° ± 1.98°, and the mean postoperative deviation was 6° ± 2.84°. Total success was achieved in four out of six eyes, and only one case remained under-corrected. No intra- or postoperative complications were reported. CONCLUSION: Inferior oblique retro-equatorial myopexy is an alternative surgical approach for inferior oblique overaction. It is an efficient, safe, and reversible technique that could be used in cases of inferior oblique overaction between 2+ to 3+

Inferior oblique retro-equatorial myopexy: An alternative weakening. / Miopexia retroecuatorial del músculo oblicuo inferior: un debilitamiento alternativo.

PURPOSE: To describe an alternative surgical approach to treat inferior oblique overaction, and report the first results of this technique. MATERIALS AND METHODS: A total of 6 consecutive eyes of 6patients with primary or secondary inferior oblique overaction underwent inferior oblique retro-equatorial myopexy under general anaesthesia. The primary outcomes measured were the postoperative vertical deviation in the field of action of the inferior oblique muscle, and the intra- and postoperative surgical complications. Final results were evaluated at six-months after surgery. RESULTS: The patient population consisted of 3girls and 3boys aged between 4 and 7years old. The mean preoperative inferior oblique overaction was 34°±4.6°, equivalent to 3+. Inferior oblique overaction was reduced in all patients with a mean reduction of 28°±1.98°, and the mean postoperative deviation was 6°±2.84°. Total success was achieved in four out of six eyes, and only one case remained under-corrected. No intra- or postoperative complications were reported. CONCLUSION: Inferior oblique retro-equatorial myopexy is an alternative surgical approach for inferior oblique overaction. It is an efficient, safe, and reversible technique that could be used in cases of inferior oblique overaction between 2+ to 3+.

Grave complicación en el transcurso de una cirugía de estrabismo / Severe complication during strabismus surgery

CASO CLÍNICO: Paciente de 4 años de edad, que como consecuencia de una inyección de triamcinolona subtenoniana en la región de la tróclea del ojo derecho al finalizar una cirugía para el síndrome de Brown presenta un hematoma orbitario inmediato que al cabo de una semana, cuando se pudo explorar mejor, puso en evidencia la presencia de una mancha rojo-cereza secundaria a la embolización de la arteria central de la retina por cristales de triamcinolona. DISCUSIÓN: La triamcinolona es un antiinflamatorio de uso corriente en oftalmología para el tratamiento de afecciones variadas. Aunque excepcional, se ha descrito que su utilización puede provocar embolizaciones por entrada del esteroide en la circulación

CLINICAL CASE: A 4-year-old patient, who presented with an immediate orbital haematoma as a result of a subtenon injection of triamcinolone in the trochlear region of the right eye on finishing a surgical procedure for Brown's syndrome. After one week, when it could be examined better, the presence of a cherry red spot was observed due to the embolisation of the central artery of the retina by triamcinolone crystals. DISCUSSION: Triamcinolone is an anti-inflammatory drug currently used in Ophthalmology for the treatment of various conditions. Although exceptional, it has been described that its use may provoke embolisations due to the entry of the steroid into the circulation

Severe complication during strabismus surgery.

CLINICAL CASE: A 4-year-old patient, who presented with an immediate orbital haematoma as a result of a subtenon injection of triamcinolone in the trochlear region of the right eye on finishing a surgical procedure for Brown's syndrome. After one week, when it could be examined better, the presence of a cherry red spot was observed due to the embolisation of the central artery of the retina by triamcinolone crystals. DISCUSSION: Triamcinolone is an anti-inflammatory drug currently used in Ophthalmology for the treatment of various conditions. Although exceptional, it has been described that its use may provoke embolisations due to the entry of the steroid into the circulation.

La estrabología en el siglo XXI / Strabology in the 21st century

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