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Dosage of Eye Muscle Surgery in Endocrine Orbitopathy
Published in Jan-Tjeerd de Faber, 28th European Strabismological Association Meeting, 2020
K.-P. Boergen, G. Rudolph, O. Ehrt, P. Kalpadakis
Motility problems in chronic thyroid eye disease are caused by fibrosis and /or lipomatosis of the eye muscles, leading to a mechanical restriction of eye movements. Usually the inferior rectus muscles are most involved. Therefore elevation is limited in most cases. Some do suffer from limitation of abduction caused by fibrosis of the medial rectus muscle. After stabilization of the endocrine and orthoptic status for at least 6 months surgical rehabilitation should be planned in all patients suffering from double vision or a marked chin elevation. Since eye movements are mechanically restricted the primary aim of any surgery is normalization of motility and not correction of squint angles. Therefore recessions of the most involved muscle is the preferred procedure. Common rules for the dosage can not be applied as the elastic properties of the eye muscles are severely altered. This problem can be overcome in three different ways: preoperative determination of the amount of recessionintraoperative dosage using active or passive motilitypostoperatively with adjustable sutures.
Effects of Alternating Fixation on the Binocular Alignment of Listing’s Plane
Published in Michael Fetter, Thomas Haslwanter, Hubert Misslisch, Douglas Tweed, Three-Dimensional Kinematics of Eye, Head and Limb Movements, 2020
J.A.M. Van Gisbergen, B.J.M. Melis, J.R.M. Cruysberg
Eye movements were recorded binocularly with the dual search coil method while the head was fixed in an upright position. In addition to a 24 year old strabismus patient (SP), we also studied four normal control subjects. The oculomotor data were collected to test the validity of Listing’s plane in far vision, to assess the alignment of the two planes and to determine the effect of alternating fixation. The patient has normal visual acuity in his dominant right eye and near normal acuity in his left eye which has an uncorrected hypermetropia of +1.75 diopters in distant vision. He was operated twice, before the age of six, to correct esotropia of the left eye. The first operation involved anterior transposition of the inferior oblique muscle in the right eye and recession of the medial rectus muscles in both eyes. In a subsequent operation, a residual misalignment was further reduced by a recession of the inferior rectus muscle of the left eye. Having a suppression zone exceeding 35 deg, the patient lacks stereoscopic vision. Data about his ocular misalignment, which depends on which eye is fixating, will be provided below.
Extraocular muscle surgery for torsion and strabismus associated with macular translocation surgery (MT360)
Published in A Peyman MD Gholam, A Meffert MD Stephen, D Conway MD FACS Mandi, Chiasson Trisha, Vitreoretinal Surgical Techniques, 2019
The lateral rectus muscle is then transposed superiorly, and attached adjacent to the temporal edge of the superior rectus muscle, approximately 7 mm from the limbus. In a similar fashion, the medial rectus muscle is transposed inferiorly and attached adjacent to the nasal border of the inferior rectus muscle. Silicone oil removal can then be performed by the vitreoretinal surgeon immediately following muscle surgery. Alternatively, the silicone oil can be delayed for 4–6 weeks after extraocular muscle surgery.
Long term ophthalmic complications of distal arthrogryposis type 5D
Published in Ophthalmic Genetics, 2023
Dana Cohen, Ronen Sloma, Hadas Pizem, Ayalla Fedida, Limor Kalfon, Relli Ovadia, Zvi Segal, Yanir Kassif, Tzippi Falik Zaccai
Ptosis is the main characteristic of DA5D; however, its etiology is not well understood. Based on our clinical examination: the lack of eyelid crease and the poor levator function, we assume that this ptosis might be congenital and of myogenic nature, possibly due to fibrosis of the levator palpebrae muscle. This hypothesis conflicts the possible neurogenic etiology of DA5D syndrome (31), and more specifically the possible neurogenic basis of the ptosis seen in our patients. Other than poor levator function we also noticed limitation in up gaze which was previously described (5). We assumed that this is due to fibrosis of the inferior rectus muscle as seen in the retractors of the lower eyelid. In order to test this hypothesis, we performed force duction test and noticed restriction in elevation, suggesting inferior rectus fibrosis. Nagata knocked out mice showed axon guidance defects of the sixth cranial nerve, while other ocular motor nerves did not show this difference (32). However, different phenotypes of DA5D exist. Whether the guidance defect is the reason for the possible fibrosis of the inferior rectus remains unclear. We suggest that fibrosis continues to evolve as patient ages, and should be further investigated by direct quantification of these features in other patients in childhood and as they grow up. We obviously weren’t able to perform such examinations in our patients due to their late presentation.”
OnabotulinumtoxinA injection towards the SPG for treating symptoms of refractory chronic rhinosinusitis with nasal polyposis: a pilot study
Published in Acta Oto-Laryngologica, 2021
Kent Are Jamtøy, Erling Tronvik, Daniel Fossum Bratbak, Joan Crespi, Lars Jacob Stovner, Irina Aschehoug, Wenche Moe Thorstensen
Nine out of 10 patients experienced AEs, none were serious (Figure 2). One patient experienced diplopia which moderately affected his daily activities. An ophthalmologist diagnosed a moderate paresis of the inferior rectus muscle with hypertropia in abduction. The symptoms slowly improved and resolved 4 weeks after injection. Two patients experienced nasolabial fold asymmetry, appearing 4 weeks after injection and resolving spontaneously 7 and 12 weeks after injection, respectively. The AE did not require any treatment and was not considered bothersome by the patients. Two patients had pain or swelling at the injection site that resolved within the first month after injection. One of them had to take additional analgesics on the day of injection. Seven patients reported discomfort in the jaw at maximal gaping, which did not interfere with chewing, eating, or speaking and there was no need for analgesics or further treatment. One patient experienced a burning sensation of the tongue that resolved spontaneously within 2 weeks after injection. One patient experienced blurred vision the same evening as the injection, assumed to be due to the local anaesthesia.
An algorithm for Botulinum toxin A injection for upper eyelid retraction associated with thyroid eye disease: long-term results
Published in Orbit, 2021
Gamze Ozturk Karabulut, Korhan Fazil, Basak Saracoglu Yilmaz, Can Ozturker, Zehra Karaağaç Günaydın, Muhittin Taskapili, Pelin Kaynak
Different mechanisms have been reported for the upper eyelid retraction due to TED.3 The first mechanism is the muscle hyperactivity in the active stage of the disease, which involves the levator palpebrae superioris (LPS) – superior rectus muscle complex and the Müller’s muscle. Increased stimulation of the muscle complex to overcome the restriction of the inferior rectus muscle and to maintain the vertical eye alignment may lead to an upper eyelid retraction.3–6 Müller’s muscle hyperactivity due to sympathetic activity of thyroid hormones is another mechanism that leads to temporary lid retraction in patients with a poor metabolic control in the early stages of the disease.3,7,8 Reduced tonus of orbicularis oculi muscle with reduced number of muscle fibers as shown by Harrison and McLoon in rabbits with hyperthyroidism may also contribute to retraction by causing a relative levator muscle overaction.9