[Möbius sequence: long-term strabismus surgical outcome]. / Seqüência de Möbius: resultados a longo prazo, da correção cirúrgica do estrabismo.

PURPOSE: To analyze the long-term results in a consecutive series of Möbius sequence patients, who underwent surgical correction of strabismus. METHODS: Ten patients with Möbius sequence fulfilled the inclusion criteria of this study. All patients presented esotropia at the preoperative examination, above or equal to 15 prismatic diopters (DP) varying from 15 to 85. All patients presented lateral rectus muscles severe underaction, six presented hipertropia above or equal 10 DP associated with esodeviation, and five presented anisotropia in A or in V. The patients were operated upon protocol, in a consecutive way, in July 2002. Patients were reexamined periodically, and at 2nd postoperative year as for: the visual acuity; deviation measurements; ocular rotations; cosmetic aspect and socialization. RESULTS: The patients presented satisfactory surgical results in eight cases, considering an eso or exodeviation up to 15 DP and a hipertropia lower than 10 DP. Four (40%) patients presented correction of the preoperative anisotropia. Variation of ocular deviation in the primary position (from the 90th day to the 2nd postoperative year was observed) in 9 patients (90%), demonstrating that strabismus surgical stabilization needs time. CONCLUSIONS: The surgical results were considered satisfactory, improving patient self-esteem and the parent satisfaction, making the social inclusion easier.

[New surgical approach in the treatment of incomitant strabismus: case report]. / Nova abordagem cirúrgica no tratamento de estrabismos incomitantes: relato de caso.

The authors report the utilization of the surgical technique proposed by Scott, in 1994, of recess and resection of the same extraocular muscle in the treatment of incomitant horizontal strabismus. A 22-year-old female presented with incomitant strabismus, with an esotropia of 9delta for distant and 30delta for near. She was submitted to a recess and resection of the right medial rectus. She presented satisfactory results in the long-term, showing that this technique could be part of the therapeutic arsenal for correction of incomitant strabismus.

Tissue adhesives for a sutureless fadenoperation: an experimental study in a rabbit model.

PURPOSE: To use tissue adhesives for a sutureless Fadenoperation to eliminate perioperative risks related to the sutures. METHODS: In an in vivo procedure, 120 superior recti muscles in New Zealand White rabbits were subjected to the posterior fixation procedure, at a distance of 6 mm from the insertion point of the muscle. They were divided into four groups of 30 muscles, according to the material used to perform a myopexy: group 1 (control): nonabsorbable 5-0 polyester sutures; group 2: n-butyl-2-cyanoacrylate adhesive; group 3: fibrin glue; group 4: gelatin-resorcin-formaldehyde-glutaraldehyde (GRFG) adhesive. The animals were examined at 1, 7, 14, and 21 days after surgery. Afterward, they were killed, and their eyes were enucleated to measure the distance between the myopexy and the anatomic insertion point and to assure the strength of the bond with a dynamometer. Finally, a histologic examination was performed. RESULTS: Almost all eyes were clear after the third week, although group 4 presented the most intense inflammatory reaction. In histologic examination, groups 1 and 2 showed a chronic inflammatory reaction of the foreign-body type, with similar intensity. Fibrin glue induced minimal inflammation, but GRFG adhesive produced a pronounced reaction. Concerning the distance of the myopexy, groups 1 and 2 presented measures close to the expected distance of 6 mm, whereas groups 3 and 4 showed a greater variability. All groups performed well in the strength test, with no statistically significant differences among them. CONCLUSIONS: n-Butyl-2-cyanoacrylate adhesive performed best in the sutureless Fadenoperation, characterized by precision in the expected distance of myopexy, sufficient resistance to separation, and acceptable inflammatory reaction.