Boergen modification of Harada-ito surgery with and without vertical muscle surgery for acquired unilateral superior oblique muscle palsy.

PURPOSE: The purpose is to report the results of the Boergen modification of the Harada-Ito procedure with and without simultaneous vertical muscle surgery in patients with acquired unilateral superior oblique muscle palsy. PATIENTS AND METHODS: Files of patients with acquired unilateral superior oblique muscle palsy who were treated with Boergen modification of the Harada-Ito procedure were studied retrospectively. For each patient, age at the time of surgery, the presence of diplopia, compensatory head posture, and ocular deviation before and after surgery were retrieved. Results were evaluated 6 months after surgery. RESULTS: A total of 12 patients with a mean age of 32 years at the time of surgery (range 15-45 years) were included. The underlying etiology was head trauma in eleven patients. The modified Harada-Ito procedure alone was done for three cases (Group 1), and a simultaneous combination of this procedure and vertical muscle surgery was performed in nine patients (Group 2). The average intorsional effect in the primary position was 9.2° (8° in Group 1 and 9.6° in Group 2). The average correction of hypertropia in the primary position was 8.2 prism diopters (PD) (1 PD in Group 1 and 10.6 PD in Group 2). Diplopia in the primary position and downgaze were resolved in eleven patients and ten patients, respectively. Four patients had a compensatory head tilt at their last follow-up. CONCLUSIONS: Boergen modification of the Harada-Ito procedure, alone and combined with vertical muscle surgery, successfully corrected primary position diplopia in the majority of the patients.

Outcomes of "a new modification of Jensen technique combined with medial rectus recession" in patients with complete sixth cranial nerve palsy.

BACKGROUND: To report the outcomes of "our modified Jensen technique" for treating esotropia in cases with complete sixth cranial nerve (CN VI) palsy. METHODS: This study is a 30-year case series of isolated complete CN VI palsy who underwent combined medial rectus recession and our modified Jensen operation. We modified the original technique by anchoring the muscle-unifying sutures to the sclera near the equator using a non-absorbable suture. Major outcomes such as postoperative diplopia, face turn, horizontal and vertical eye deviations, and abduction limitation were assessed. Successful surgery was defined as orthotropia or esotropia equal to or less than 8 prism diopters (PD) and the absence of any vertical deviation. RESULTS: Fifty-three cases with a mean age of 28 years old were included in this study. The male-to-female ratio was 3 to 1. Forty-five cases (85%) presented with unilateral palsy, whereas 8 patients (15%) had bilateral palsy. Trauma was the most common etiology (85%). Diplopia or face turn, presented in 42 patients before the operation, remained in seven cases after the operation. Primary position esotropia, which was the main complaint in all patients, decreased from 49 PD to 4 PD in unilateral palsy and from 101 PD to 10 PD in bilateral palsy. The mean reduction of abduction deficit was 1.78 in unilateral and 1.75 in bilateral palsy. The success rate was 76% in unilateral and 62% in bilateral palsy. CONCLUSION: Our modified Jensen operation was effective in treating patients with complete CN VI palsy, producing no significant permanent complications.

Case report: Mirror-image hypermetropic anisometropia in nontwin brothers.

Mirror-image is a term to describe a physical characteristic of some identical twins that appear asymmetrically on opposite sides as if they are looking in a mirror. Mirror-image anisometropia in monozygotic twins was previously reported in the ophthalmic literature. In this article, we describe a case of mirror-image hypermetropic anisometropia in siblings aged 8 and 5 years old. Nontwin brothers, 8 and 5 years old, with mirror-image hypermetropic anisometropia, were referred to the pediatric ophthalmology clinic. Corrected distant visual acuity was 20/20 (ocula dextra [OD]), 20/60 (ocula sinistra [OS]) in the older brother, and 20/50 (OD), 20/20 (OS) in the younger brother. Cycloplegic refraction was + 3.5 - 1.25 × 180 (OD), +7.75 - 1.5 × 30 (OS), and + 7.0 - 0.75 × 20 (OD), +2.0 - 1.0 × 170 (OS) in the older and younger brother, respectively. The axial length difference between the two eyes was 1.47 mm in the older and 2.01 mm in the younger brother. Hypermetropic anisometropia that may lead to anisometropic amblyopia may happen in nontwin brothers. This emphasizes the importance of complete ophthalmologic examination in the siblings of all patients with anisometropia.

Long-term results of strabismus surgery for treatment of esotropia in patients with Möbius syndrome.

PURPOSE: To evaluate the surgical results of Möbius syndrome esotropia following bilateral medial rectus recession with and without bilateral Hummelsheim procedure. METHODS: The medical records of patients with Möbius syndrome operated on by a single surgeon from 1993 to 2022 were studied retrospectively. For each patient, age, sex, and ocular deviation before and after surgery were retrieved. Success was defined as a horizontal deviation of up to 15Δ and vertical deviation of <10Δ. RESULTS: Eleven patients were included. Average patient age at the time of surgery was 4 years. Eight patients with esodeviation up to 70Δ underwent bilateral medial rectus recession; 3 patients with esotropia >70Δ underwent recession plus bilateral Hummelsheim procedure. The mean esodeviation before surgery was 52.5Δ in the first group and 86.6Δ in the second group. The mean horizontal deviation at early follow-up was esotropia of 7.4Δ in the first group and of 15Δ in the second group. The early success rate was 87% in the first group and 67% in the second group. Long-term follow-up revealed exoshift in 43% of the patients in the first group and all 3 patients in the second group. CONCLUSIONS: In our small patient cohort of patients with Möbius syndrome, bilateral medial rectus recession corrected esodeviations of up to 70Δ. In more severe cases (>70Δ), adding bilateral Hummelsheim procedure was beneficial.

Mirror image hypermetropic anisometropia in a pair of monozygotic twins.

In monozygotic twins two embryos are formed from a single fertilized egg. In "mirror image twins" identical siblings have reverse asymmetric features in the right and left sides of the body. We report the case of twins with mirror-image hypermetropic anisometropia. They were referred to an ophthalmologist at the age of 3.5 years for amblyopia. Cycloplegic refraction of twin 1 was +1.00 in the right eye and +4.50 -0.75 ×180 in the left eye; of twin 2, +4.75 -1.00 ×180 and +1.25. Keratometry and axial length were measured with Lenstar LS 900 when the twins were 6 years of age. In twin 1, the axial length was 22.18 mm in the right eye and 20.97 in the left eye; in twin 2, 20.94 mm and 22.13. Keratomtry of both eyes of these twins was relatively equal.

Combined Lateral Rectus Myectomy and Maximal Medial Rectus Resection in Complete Third Cranial Nerve Palsy.

This study was performed to describe lateral rectus myectomy and maximal medial rectus resection for correction of eye deviation in complete third cranial nerve palsy. A retrospective review of thirteen patients (fourteen eyes) with complete third cranial nerve palsy, who underwent lateral rectus myectomy and maximal medial rectus resection, was performed. These procedures were combined with superior oblique tendon transposition in nine patients with a large angle of exotropia (more than 60 prism diopters [∆]), or significant hypotropia (more than 5 ∆). Preoperative deviations were exotropia of 50 to 120 ∆ in thirteen cases and hypotropia of 5 to 25 ∆ in eight cases. Six months after the surgery, eleven patients were within 10 ∆ of orthotropia in primary position. Revision surgery was performed for two patients, eight and 18 months after the first operation. Eventually, five patients (38%) achieved orthotropia in the primary position, and seven patients (54%) had < 11 ∆ exotropia and < 6 ∆ vertical deviation. In conclusion, this procedure can be considered as an acceptable approach for treatment of strabismus in complete third cranial nerve palsy. This procedure is simple and can be easily performed even in very young children.