Gang Seok Jeon; Mi Young Choi; Dong Gyu Choi

doi:10.3341/jkos.2010.51.3.401

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Jeon, Choi, and Choi: The Cshange of Rectus Muscle Length Caused by Traction With Muscle Hooks in Strabismus Surgery– the First Report

Original Article

J Korean Ophthalmol Soc 2010;51(3):401-405.

Published online: 25 September 2010

DOI: https://doi.org/10.3341/jkos.2010.51.3.401

The Cshange of Rectus Muscle Length Caused by Traction With Muscle Hooks in Strabismus Surgery– the First Report

Gang Seok Jeon, MD¹, Mi Young Choi, MD, PhD², Dong Gyu Choi, MD, PhD^1,

¹Department of Ophthalmology, Hallym University, Kangnam Sacred Heart Hospital, College of Medicine, Seoul, Korea

²Department of Ophthalmology, Chungbuk National University College of Medicine, Chungbuk National University Medical Research Institute, Cheongju, Korea

Address reprint requests to Dong Gyu Choi, MD, PhD Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine #948-1 Daerim-dong, Yeongdeungpo-gu, Seoul 150-950, Korea Tel: 82-2-829-5193, Fax: 92-2-848-4638, E-mail: eyechoi@dreamwiz.com

Received 23 March 2009 Accepted 2 December 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate changes in muscle length when retracting the extraocular rectus muscle with muscle hooks during strabismus surgery.

Methods

Forty-four rectus muscles of 42 patients consecutively resected in two hospitals (A, B) were included in this study. After isolation of the rectus muscle, the length of the muscle was recorded and the portion to be resected was marked using gentian violet stain on the tip of calipers. After the rectus muscle was retracted with two muscle hooks in either direction, its length was measured again with the calipers.

Results

The length of the rectus muscle was not changed by retraction in 25 of 44 muscles (56.8%). The length of the muscle was changed by 0.5 mm in 13 muscles (29.5%) and by 1mm in six muscles (13.6%). Changes of rectus muscle length over 0.5 mm were observed in 15 of 27 muscles of patients treated at hospital A (55.5%) and four of 17 muscles of patients treated at hospital B (23.5%). The results for the two hospitals were significantly different (p=0.037).

Conclusions

Small errors in measurement can occur when muscle resections are performed during strabismus surgery. Institutional or clinician related factors may explain variations in error rates between hospitals.

Keywords: Change of rectus muscle length, Strabismus surgery, Traction with muscle hook

References

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Figure 1.

(A) Medial rectus muscle was retracted with Jameson muscle hook. The resection amount was marked with Gentian violet (white arrow). (B) This picture shows the discrepancy between the resection amount (caliper) and the elongated rectus muscle length (white arrow) after retraction second Jameson muscle hook (white arrow head).

Table 1.

Demographic data of patients

Number of patients	42
Sex (No. Male/Female)	19/23
Mean age (Mean ± SD, year)	13.12±13.17
Distant deviation angle (Mean± SD, PD^*)	29.24±13.60
Near deviation angle (Mean± SD, PD^*)	31.37±14.23
Diagnosis (No. XT^†/ET^‡/Vertical strabismus)	37/4/1
Muscle (No. MR^§/LR^∏, /SR^∏)	39/4/1

^* PD: Prism diopter

^† XT: Exotropia

^‡ ET: Esotropia

^§ MR: Medial rectus muscle

^∏ LR: Lateral rectus muscle

^＃ SR: Superior rectus muscle

Table 2.

Statistical analysis of clinical factors between groups

Factors	Group 1	Group 2	P-value
A Hospital (%)/B Hospital (%)	73%/27%	31%/69%	0.037^*
Sex (No. Male/Female)	7/11	12/14	0.900^*
Age (Mean± SD, year)	13.44±13.32	12.87±13.30	0.890^†
Diagnosis (No. XT^‡/ET^§/Vertical strabismus)	17/1 / 0	22/3/1	0.487^*
Muscle (No. MR^∏/LR^＃/SR^**)	17/1 / 0	22/3/1	0.487^*
Planned resection amount (Mean± SD, mm)	5.08±1.11	5.36±0.87	0.190^†

Group 1: The increase of resection amount after second muscle hook pulling≥0.5 mm, Group 2: The increase of resection amount after second muscle hook pulling<0.5 mm

^* Pearson Chi-square test

^† independent sample t-test

^‡ XT: Exotropia

^§ ET: Esotropia

^∏ MR: Medial rectus muscle

^＃ LR: Lateral rectus muscle

^** SR: Superior rectus muscle.

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