Effects of Alternating Fixation on the Binocular Alignment of Listing’s Plane
Michael Fetter, Thomas Haslwanter, Hubert Misslisch, Douglas Tweed in Three-Dimensional Kinematics of Eye, Head and Limb Movements, 2020
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.
The Frankfurt technique of macular translocation
A Peyman MD Gholam, A Meffert MD Stephen, D Conway MD FACS Mandi, Chiasson Trisha in Vitreoretinal Surgical Techniques, 2019
After the circular opening of the conjunctiva and exposure of the superior rectus and superior oblique muscles, an 8–10 mm tuck is made by folding over a spatula. A nasal muscle strip of the superior rectus is prepared and brought under the superior rectus and attached to the superior insertion of the lateral rectus muscle with a double 6-0 Vicryl suture. The lateral rectus muscle is exposed; the 8–10 mm inferior oblique muscle is recessed according to the Fink method. The inferior oblique muscle is exposed. A temporal muscle strip is prepared; it is crossed under the residual rectus and reattached to the inferior insertion of the medial rectus muscle with a double-armed 6-0 Vicryl suture.
Blepharoplasty
John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford in Head & Neck Surgery Plastic Surgery, 2018
Diplopia is a rare complication following lower eyelid blepharoplasty. This is usually due to surgical trauma to the inferior oblique muscle. A good knowledge of anatomy, a meticulous surgical dissection and an avoidance of the excessive use of cautery should prevent such a complication. A permanent ocular motility disturbance caused by blepharoplasty is much rarer than a pre-existing phoria, which may decompensate following surgery. For this reason it is imperative to perform a detailed pre-operative ophthalmic examination in order to diagnose the problem and to protect the surgeon from unfair blame.
Inferior oblique muscle belly transposition and myopexy for diplopia
Published in Strabismus, 2021
Pilar Merino-Sanz, Amanda Chapinal, Pilar Gómez de Liaño Sánchez, Fabio Zavarse Fadul
The purpose of this technique is to correct deviation in primary gaze position and mild or moderate upshoot in adduction. The surgical effect is greater or weaker depending on the point at which the muscle is sutured to the sclera.1 The limited literature published has demonstrated that inferior oblique muscle fixation to sclera 5 mm posterior to the temporal pole of the inferior rectus can correct small-angle hypertropia <5 pd in straight gaze and mild-to-moderate upshoot in adduction. This technique creates a new muscle insertion diminishing the contact arch of the muscle as it does for the posterior fixation of a rectus muscle or as a recession-resection, producing minimal effect in the primary position but reducing muscle function in its specific gaze. Leaving the origin and the insertion intact, a transposition will make the muscle tighter. That it still works, could be caused by a different direction of pull of the muscle and by the trauma to the muscle, caused by the myopexia and because the part of the inferior oblique muscle that courses over the globe, has been fixed to the globe in an extended position. The functional origin of the inferior oblique muscle is near the temporal border of the inferior rectus where this muscle becomes attached by its sheath to the suspensory Lockwood ligament.9–11
Compartmental Strabismus
Published in Journal of Binocular Vision and Ocular Motility, 2020
Stacy L. Pineles, Melinda Y. Chang, Federico G. Velez
The vertical rectus muscles are even less compartmentalized. There is no compartmentalization for the superior rectus muscle as it has been shown to receive mixed innervation throughout the entire muscle width.2 The inferior rectus muscle innervation is also more intermingled than that of the horizontal muscles. One study showed selective innervation of the temporal third of the muscle1 but most of the inferior rectus is innervated by a lateral trunk that extends over the entire inferior rectus muscle with a smaller selective innervation to the medial portion of the muscle.2 Interestingly there is evidence of some innervational anastomosis between the medial compartment of the inferior rectus muscle and the medial rectus muscle.2 Also there is some innervational overlap between the inferior rectus muscle and the inferior oblique muscle.2
Surgical treatment for small-angle vertical strabismus
Published in Strabismus, 2020
Pilar Merino Sanz, Verónica Osuna, Pilar Gómez de Liaño Sánchez, Hernán Eduardo Donoso Torres
Traditionally, small-angle vertical strabismus has been successfully treated with prisms, although incomitant deviations are not always tolerated with this approach.1 Other surgical techniques based on modifications of adjustable sutures have also been published,13 and surgery on the inferior oblique muscle without disinsertion was recently found to eliminate small-angle hypertropia with mild or moderate overaction of the inferior oblique in patients with DVD, and oblique superior paresis.14,15 Botulinum toxin is a good therapeutic option in small-angle horizontal strabismus.16 However, while the injection of botulinum toxin into the vertical rectus can correct small deviations, it may be associated with adverse effects by diffusion to adjacent muscles (inferior oblique when injecting the inferior rectus and vice versa).17,18 In this study, 11 of the 17 cases had received prior treatment with repeated injections of botulinum toxin with partial and/or temporary resolution of their diplopia, albeit with a poor long-term outcome.
Related Knowledge Centers
- Eye
- Inferior Rectus Muscle
- Lateral Rectus Muscle
- Maxilla
- Oculomotor Nerve
- Sclera
- Orbit
- Extraocular Muscles
- Lacrimal Groove
- Common Tendinous Ring