2018 - 4 Issue

Original article

Vertical Strabismus - Indication of Surgical Techniques on the Inferior Rectus Muscle

Jan Krásný ORCID

Full Text links

DOI: 10.31348/2018/1/2-4-2018

Published in Czech and Slovak Ophtalmology: 2018 - 4

Published on website: 18.03.2019

Keywords: adjustable sutures, congenital fibrosis of the extraocular muscles, double elevator palsy, thyroid eye disease, transposition procedure sec. Knapp, vertical strabismus

Summary

Aid: Familiarize themselves with the operating techniques in their own modulation to solve hypotropic states with elevation or hypotropic states with depression.

Methods: Surgery technique “cul-de-sac” is a procedure with fixed adjustable sutures (non-absorbable suture), which are guided in parallel on both peaks original insertion of inferior rectus muscle. The node itself of suture is done in cutting the muscle and through the original insertion only leads arc suture. During „counterclockwise transposition“ procedure sec. Knapp, the horizontal rectus muscles are fixed at the straight inferior rectus muscle level. The author included their graphical diagrams.

Material: At the Department of Ophthalmology in the Faculty Hospital Královské Vinohrady in Prague (Czech Republic, EU) in the years 1996 - 2014 a release relaxing operation of the inferior rectus musle by the technique “cul-de-sac” on 49 eyes. Indication was double elevator palsy in 31 patients, congenital fibrosis of the extraocular muscles in 15 patients and in 3 cases, it was thyroid eye disease. “Counterclockwise transposition” procedure sec. Knapp was indicated twice for paresis of the inferior rectus muscle in 2015 and 2016. For the first time, it was a congenital form. It was detected histologically atrophy of stripped muscle with hypertrophy collagen. The second traumatic form was formed after an orbital injury.

Results: We provided adequate relaxation of the inferior rectus muscle and practical restoration of eye elevation by the technique “cul-de-sac“ in 18 preschool children with the double elevator palsy and three adult patients with thyreiod eye disease. We had to restore motility to complete the procedure by classical transposition procedure sec. Knapp of both horizontal rectus muscles to the direct superior rectus muscle in elderly children and adults with the double elevator palsy, as well as in all patients with the congenital fibrosis of the extraocular muscles. Indicate the inclusion of this transposition influenced the degree of fibrotic rectus inferior muscle given by age. “Counterclockwise transposition“ procedure sec. Knapp ensured the practical disappearance hypertropie in both cases of paresis of the inferior rectus muscle. The alignment of the position of the eyes without diplopia in the direct view was ensured by prismatic correction.

Conclusions: To release the fibrotically altered inferior rectus muscle in the double elevator palsy, the congenital fibrosis of the extraocular muscles and the thyroid eye disease, the operation of adjustable sutures was necessary in accordance with our experience with the technigue “cul-de-sac“ in its own modification. The transposition procedure sec. Knapp, either classical or “”counterclockwise” “ in its own modification, was of paramount importance for the solution of the vertical deviation of a paretic ethiology.

References

  1. Autrata, R., Unčovská, Hromádková, L. et al.: Vertical deviation in children. Folia strabologica et neuroophthalmologica, 5; 2002 suppl. I.: 39–44.
  2. Chang, JH., Hutchinson, AK., Zhang, M. et al.: Strabismus surgery outcomes after scleral bucking procedures for retinal reattachment. Strabismus, 21; 2013: 235 - 241
  3. Divišová, G. et al.: Strabismus, Avicenum, Praha, 1979, 306 p.
  4. Docherty, PTC.: Paralytic strabismus correction by adjustable suture technique, Br J Ophtalmol, 68; 1984: 353 – 359.
  5. Dostálek, M., Krejčířová, I.: Chirurgické tonické složky strabi - smu – teoretické aspekty. Folia strabologica et neuroophthalmologica, 17; 2016 suppl. I.: 35.
  6. Fišerová, O.:Disociovaná vertikalna divergencia – charakteristika a liecba. Folia strabologica et neuroophthalmologica, 6; 2003, suppl. I.: 45–47.
  7. Gerinec, A.: Detská oftalmológia, Osveta, Martin, 2005, s. 157–196.
  8. Helveston, EM.: Surgical Management of Strabismus, 4th ed., St. Louis, Mosby, 1993, 395 p.
  9. Karhanová, M., Vláčil, O., Šín, M. et al.: Srovnání metody nastavitelných stehů versus fixační stehy při operaci strabismu u pacientů s endokrinní orbitopatií. Ces Slov Oftal, 68; 2012: 207–213.
  10. Knapp, P.:Vertical transposition of the horizontal rectus musles for the elimination of vertical strabismus, Trans Am Ophthalmol, 67; 1969: 304–323.
  11. Keech, RV., Heckert, RR.: Adjustable suture strabismus surge - ry for acquired vertical deviation. J Pediatr Ophtalmol Strabismus, 25; 1988: 159–164.
  12. Krásný, J.: Strabismus sursoabductorius (v kontextu osmnáctiletého rozboru strabismu). Ces Slov Oftal, 71; 2015: 267–277.
  13. Krásný, J.: Vertikální strabismus I: Operační technika cul-de-sac. Folia strabologica et neuroophthalmologica, 18; 2017 suppl. I.: 102–104.
  14. Krásný J., Brunnerová, R.: Strabismus – konzervativní postupy a chirurgické metodiky. In Rozsíval, P. (ed.) : Trendy v oftalmologii, sv. 6., Galén, 2010, 56–98.
  15. Krásný, J., Kubištová, V.: Trojitá parciální myotomie dolního šikmého svalu. Posouzení s retropozicí a volnou myectomií. Cs Oftal, 48; 1992: 186–190.
  16. Krásný, J., Měřička, P.: Možnosti řešení ptózy v dětství a dospělosti. Ces Slov Oftal, 55; 1999: 145–155.
  17. Krásný, J., Měřička, P.: Dvě desetiletí zkušeností s využitím hluboce zmražené fascie u operace neurogenních ptóz v rámci neurooftalmologických diagnóz. Folia strabologica et neuroophthalmologica, 15; 2014, suppl. I.: 45–47.
  18. Krásný, J., Šach, J.: Klinicko-patologický stav po operaci „na - stavitelnými stehy“. Folia strabologica et neuroophthalmologica, 17; 2016: suppl. I.: 51–53.
  19. Krásný, J., Šach, J.: Vertikální strabismus II: Operační technika protisměrné Knappovy transpozice. Folia strabologica et neuroophthalmologica, 19; 2018, suppl. I.: 61–63.
  20. Mims, J.L., Wood, R.C.: Bilateral anterior transposition of infe - rior oblique muscle. Arch Ophthalmol, 107; 1989: 41 – 44.
  21. Nelson, LB., Calhoun, JH., Harley, RD. et al.: Cul-de-sac approach to adjustable strabismus surgery. Arch Ophthalmol, 100; 1982: 1305–1307.
  22. Otradovec, J., Vacek, J.: Jednostranná supranukleární obrna elevátorů. Cs Oftal, 31; 1975: 241 252
  23. Otradovec, J.. Klinická neurooftalmologie. Grada, Praha, 2003, 487 p.
  24. Pellarová, H., Autrata, R., Uničovská et. al..: Výsledky operací vertikálních deviací. Folia strabologica et neuroophthalmologica, 13; 2012, suppl. I.: 126–128.
  25. Pur, S., Pištělka, Z.: Výsledky chirurgické úpravy vertikálních heterotropií. Cs Oftal, 18; 1962: 107–111.
  26. Rosenbaum, AK., Metz, HS., Carlson, M. et al.: Adjustable rectus muscle recession surgery. Arch Ophthalmol, 95; 1977: 817–820.
  27. Scott, WE., Martin-Casals, A., Jackson, OB.: Adjustables sutures in strabismus surgery. J Pediatr Ophthalmol Strabismus, 14; 1977: 71–75.
  28. Sprague, CE., Moseley, MJ., Fielder, AR. et al.: Dissociated vertical deviation treatment with the Faden-operation of Cuppers. Arch Ophthalmol, 98; 1980: 465–468.
  29. Tawfik, HA., Rashad, MS.: Surgical management of hypotropia in congenital fibrosis of extraocular muscles presented by pseudoptosis. Clin Ophthalmol, 7; 2013: 1– .
  30. Varadyová, B., Pellarová, H., Autrata, R. et al.: Výsledky operací vertikálních deviací. Folia strabologica et neuroophthalmologica, 14; 2013, suppl. I.: 88–91.
  31. Vasconcelos, GC., de Almeida, HC. : Adjustable versus non-adjustables suture technique for concomitant horizontal strabismus: a comparative study. Arq Bras Oftalmol, 78, 2015: 1–7 .
  32. Vodičková, K., Autrata, R., Řehůřek, J.: Anterior transposition and myectomy of the inferior oblique muscle in vertical deviations – long term results. Folia strabologica et neuroophthalmologica, 8; 2007, suppl. I.: 38–41.
  33. Vodičková, K., Autrata, R., Řehůřek, J.: Dlouhodobé výsledky anteriorizace a myectomie dolního šikmého svalu u vertikálních deviací. Ces Slov Oftal, 64; 2008: 157–160.
  34. Vodičková, K., Autrata R.: Chirurgická léčba komplikovaných případů strabismu. In Rozsíval, P. (ed.) : Trendy v oftalmologii, sv. 6., Galén, 2010, s. 101 – 123..
  35. von Noorden, GK., Helveston, EM.: Strabismus – Rozhodovací postupy. Folia strabologica et neuroophthalmologica, 5, 2002 suppl. II.: 130–133.
  36. von Noorden, GK.: Atlas of Strabismus, 4th ed., St. Louis, Mosby, 1995, 223 p.
  37. Wright, KW., McVey, JH.: Conjunctival retraction suture for fornix adjustable strabismus surgery. Arch Ophthalmol, 109; 1991: 138–141.
  38. Wright, KW., Hong, P.: Strabismus surgery in Wright, K.W., Spiegel, P.H.: Paediatric Ophthalmology and Strabismus. 2nd ed., New York, Springer, 2003: p. 278–291.
  39. Yoo, EJ., Kim, SH.: Modified inferior oblique transposition considering the equator for primary inferior oblique overaction (IOOA) associated with disociated vertical deviation (DVD). Strabismus, 22; 2014: 13–17.