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medial rectus palsy

Soh Youn Suh, Robert A Clark, Alan Le, Joseph L Demer
Purpose: To investigate changes in volumes of extraocular muscle (EOM) compartments in unilateral superior oblique (SO) palsy using magnetic resonance imaging (MRI). Methods: High-resolution, surface-coil MRI was obtained in 19 patients with unilateral SO palsy and 19 age-matched orthotropic control subjects. Rectus EOMs and the SO were divided into two anatomic compartments for volume analysis in patients with unilateral SO palsy, allowing comparison of total compartmental volumes versus controls...
October 1, 2016: Investigative Ophthalmology & Visual Science
Preeti Patil-Chhablani, Krishnapriya Kothamasu, Ramesh Kekunnaya, Virender Sachdeva, Vivek Warkad
PURPOSE: To evaluate the surgical outcome of augmented superior rectus transposition (SRT) and medial rectus recession (MRc) in patients with abducens nerve palsy. METHODS: The medical records of consecutive patients with abducens nerve palsy who underwent unilateral or bilateral simultaneous SRT with MRc from January 2012 to December 2014. Patients with previous strabismus surgery or botulinum toxin injection were excluded. Primary outcome measures were esotropia in primary position and abduction deficit...
October 7, 2016: Journal of AAPOS: the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus
YuePing Li, LiLi Sun, Wei Zhang, KanXing Zhao
PURPOSE: To compare surgical results of augmented and nonaugmented modified Knapp procedure, for the treatment of nonrestrictive double elevator palsies (DEP). METHODS: The medical records of patients with congenital DEP were reviewed retrospectively. Patients were divided into three treatment groups: standard transposition (group A), Foster transposition (group B), and resection transposition (group C). Pre- and postoperative vertical deviation in primary position, ocular motility, and binocular vision were compared...
September 20, 2016: Journal of AAPOS: the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus
Deniz Somer, Fatma Gul Cinar, Ahmet Kaderli, Firdevs Ornek
PURPOSE: To discuss surgical intervention strategies and innervation among patients with horizontal gaze palsy with concurrent esotropia. METHODS: Five consecutive patients with dorsal pontine lesions are presented. Each patient had horizontal gaze palsy with symptomatic diplopia as a consequence of esotropia in attempted primary gaze and an anomalous head turn to attain single binocular vision. RESULTS: Clinical findings in the first 2 patients led us to presume there was complete loss of rectus muscle function from rectus muscle palsy...
September 17, 2016: Journal of AAPOS: the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus
Erika M Ellis, Michael Kinori, Shira L Robbins, David B Granet
BACKGROUND: Pulled-in-two syndrome (PITS) is a serious complication of strabismus surgery that occurs when an extraocular muscle ruptures under tension. The purpose of this study was to establish a database of PITS patients to identify risk factors and management of PITS. METHODS: Strabismus surgeons from around the world contributed cases of PITS through an online survey. Risk factors, management, and outcomes were identified. RESULTS: A total of 40 cases of PITS from 29 physicians in 6 countries were collected...
September 16, 2016: Journal of AAPOS: the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus
Priyanka Singh, Perumalsamy Vijayalakshmi, Shashikant Shetty, Priyanka Vora, Suresh Kalwaniya
PURPOSE: To study the binocular alignment and ocular motility in patients with large-angle esotropia due to sixth nerve palsy treated with double augmented vertical recti transposition. METHODS: This was a prospective interventional study. Fifteen patients with non-resolving sixth nerve palsy who underwent surgical correction were included in the study. Fourteen patients also underwent an additional medial rectus recession. Two patients with an associated small vertical deviation had a selective augmentation of one vertical rectus muscle...
August 18, 2016: Journal of Pediatric Ophthalmology and Strabismus
Katarina Ivana Tudor, Damir Petravić, Anđela Jukić, Zlatko Juratovac
OBJECTIVE: To present a patient with a sudden onset ocular tilt reaction (OTR) and review recent knowledge and evolving insights of the underlying pathophysiological mechanisms of skew deviation and OTR. METHODS: A middle-aged hypertensive man who had previously suffered stroke with good recovery presented with sudden-onset double vision, slurred speech, ataxia, and a head tilt. Romberg test was positive. The patient denied having disturbances of visual acuity, eye pain, or recent trauma...
July 29, 2016: Seminars in Ophthalmology
Jessica Warnink-Kavelaars, R Jeroen Vermeulen, Annemieke I Buizer, Jules G Becher
AIM: To validate a detailed intramuscular needle placement protocol using passive muscle stretching and relaxing for botulinum neurotoxin type A (BoNT-A) treatment in the lower extremity of children with spastic cerebral palsy (CP), with verification by electrical stimulation. METHOD: A prospective observational study was performed in 75 children with spastic CP who received regular BoNT-A treatment under general anaesthesia (52 males, 23 females; mean age 8y 9mo, SD 3y 7mo, range 4-18y; mean body mass index 16...
July 6, 2016: Developmental Medicine and Child Neurology
M Prasanna Kumar, Sriram Krishnamurthy, V S Venkateswaran, Subramanian Mahadevan, M Lalitha, Sujatha Sistla, K Nagarajan
Melioidosis is an uncommon tropical infectious disease caused by Burkholderia pseudomallei. Neurological complications of melioidosis are extremely uncommon in infants. A 10-month-old girl is described who presented with disseminated melioidosis with subcutaneous nodules, arthritis, hepatomegaly and a lung cavity, and developed a left medial rectus palsy. Cranial MRI demonstrated mid-brain, pontine and basal ganglia micro-abscesses. Therapy with meropenem and cotrimoxazole led to resolution of the medial nerve palsy...
July 4, 2016: Paediatrics and International Child Health
Hong-Jeon Kim, Jung-Hwan Oh, Sa-Yoon Kang
Myotonic dystrophy type 1 (DM1) is caused by CTG repeat expansion in the DMPK gene in chromosome 19q13.3. External ophthalmoplegia is a rare manifestation in DM1. We report a DM1 patient confirmed by the presence of 650 CTG triplet expansions in the DMPK gene and had limitation of adduction gaze bilaterally. Brain MRI showed bilateral medial rectus muscles atrophy. Our patient provides additional evidence of ocular motor muscle involvement in DM1.
June 2016: Experimental Neurobiology
Ibrahim Erbagci, Veysi Öner, Erol Coskun, Seydi Okumus
PURPOSE: To describe a new surgical modified procedure in patients with chronic total oculomotor nerve palsy and to evaluate the results of this procedure. METHODS: Eight eyes of 6 consecutive patients who underwent strabismus surgery due to chronic total oculomotor nerve palsy were enrolled in the study. The lateral rectus muscle was split into two halves and disinserted from the sclera. The upper half of the muscle was passed under the superior rectus muscle and the inferior half of the muscle was passed under the inferior rectus muscle...
May 1, 2016: Journal of Pediatric Ophthalmology and Strabismus
Katsuhiko Ogawa, Yutaka Suzuki, Keiko Takahashi, Satoshi Kamei, Hiroshi Ishikawa
BACKGROUND: Midbrain lesion-induced oculomotor nerve palsy can be divided into the nuclear and infranuclear types. In the infranuclear type, the degree of each subtype of ocular muscle palsy usually varies. METHODS: The neuroradiological findings of 11 patients with midbrain infarction-induced oculomotor nerve palsy were analyzed. Their infarcts were grouped into rostral and caudal lesions. Each group was then divided into lesions that occurred in the paramedian and lateral regions before being subdivided further into lesions that occurred in the tegmental, central, and ventral areas...
July 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
J Anna Kim, Federico G Velez, Stacy L Pineles
BACKGROUND: Ocular neuromyotonia (ONM) is a rare motility disorder in which paroxysms of tonic extraocular muscle contraction from abnormal ocular motor nerve firing result in episodic diplopia and strabismus. Medical therapy with membrane-stabilizing agents has varied success. A surgical approach to treatment has not yet been described. We report the outcomes of strabismus surgery in patients with ONM. METHODS: We describe 3 patients with sixth nerve paresis and ONM of the affected lateral rectus muscle who underwent strabismus surgery...
September 2016: Journal of Neuro-ophthalmology: the Official Journal of the North American Neuro-Ophthalmology Society
Soh Youn Suh, Alan Le, Robert A Clark, Joseph L Demer
PURPOSE: Using high-resolution magnetic resonance imaging (MRI), we investigated whether rectus pulleys are significantly displaced in superior oblique (SO) palsy and whether displacements account for strabismus patterns. DESIGN: Prospective case-control study. PARTICIPANTS: Twenty-four patients diagnosed with SO palsy based on atrophy of the SO muscle on MRI and 19 age-matched orthotropic control subjects. METHODS: High-resolution, surface coil MRI scans were obtained in multiple, contiguous, quasicoronal planes during monocular central gaze fixation...
June 2016: Ophthalmology
Rohit Saxena, Medha Sharma, Digvijay Singh, Rebika Dhiman, Pradeep Sharma
Surgical management of complete third nerve paralysis is a challenge. While several techniques have been described over the years, they result in less than satisfactory outcomes with residual deviations in primary gaze or postoperative drifts. One of the described techniques for management of oculomotor palsy has been medial transposition of the lateral rectus muscle which provides a good surgical alternative but often can result in undercorrection. We describe a modification of the existing technique of medial transposition of the split lateral rectus by force augmentation through the use of equatorial fixation sutures resulting in an improved outcome in primary gaze alignment...
May 2016: British Journal of Ophthalmology
Muhsin Eraslan, Eren Cerman, Sumru Onal, Mehdi Suha Ogut
Aims. To report the results of lateral rectus muscle recession, medial rectus muscle resection, and superior oblique muscle transposition in the restoration and maintenance of ocular alignment in primary position for patients with total third-nerve palsy. Methods. The medical records of patients who underwent surgery between March 2007 and September 2011 for total third-nerve palsy were reviewed. All patients underwent a preoperative assessment, including a detailed ophthalmologic examination. Results. A total of 6 patients (age range, 14-45 years) were included...
2015: Journal of Ophthalmology
Yehoshua Almog, Merav Ben-David, Arie Y Nemet
Myasthenia gravis may affect any of the six extra-ocular muscles, masquerading as any type of ocular motor pathology. The frequency of involvement of each muscle is not well established in the medical literature. This study was designed to determine whether a specific muscle or combination of muscles tends to be predominantly affected. This retrospective review included 30 patients with a clinical diagnosis of myasthenia gravis who had extra-ocular muscle involvement with diplopia at presentation. The diagnosis was confirmed by at least one of the following tests: Tensilon test, acetylcholine receptor antibodies, thymoma on chest CT scan, or suggestive electromyography...
March 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Mohammed Al-Sofiani, Peterkin Lee Kwen
BACKGROUND: Diplopia is a common subjective complaint that can be the first manifestation of a serious pathology. Here, we report a rare case of midbrain infarction involving the lateral subnucleus of the oculomotor nuclear complex presenting as diplopia, with no other stroke manifestations. CASE REPORT: An 83-year-old right-handed white man with past medical history of diabetes mellitus, hypertension, dyslipidemia, and coronary artery disease presented to the emergency department (ED) with diplopia and unsteadiness...
2015: American Journal of Case Reports
Rakesh K Bansal, Ravi K Bamotra
A, 46-year-old Indian male, known hypertensive presented with left esotropia of 25  prism diopters (PD) after head injury in a roadside accident 9 months back. The deviation was constant in nature and was associated with complaints of diplopia in left lateral gaze. Traumatic sixth nerve palsy was diagnosed. The patient underwent left medial rectus recession of 5 mm and a split-tendon transposition of the left superior and inferior recti to the lateral rectus insertion (Hummelsheim procedure). On the first postoperative day, the patient developed corneal edema and anterior chamber reaction of flare 2+ and cells 2+...
June 2015: Indian Journal of Ophthalmology
Sylvia Õunpuu, Matthew Solomito, Katharine Bell, Peter DeLuca, Kristan Pierz
BACKGROUND/AIMS: Multilevel surgical intervention is a common approach for the correction of gait abnormalities in children with cerebral palsy (CP). The short-term outcomes for the combination of rectus femoris transfer, hamstring lengthening and gastrocnemius lengthening have been well documented using three-dimensional motion analysis. However, the impact of time, growth, and puberty on these short-term outcomes of this combination of procedures is not well understood. The purpose of this study was to evaluate the long-term outcomes of these procedures on gait in patients with CP...
September 2015: Gait & Posture
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