Scleral Perforation During Inferior Rectus Muscle Recession in Congenital Fibrosis of the Extraocular Muscles

Woo Seok Choi; Yoon Hyung Kwon; Won Yeol Ryu

doi:10.3341/jkos.2016.57.3.524

Journal List > J Korean Ophthalmol Soc > v.57(3) > 1010544

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Choi, Kwon, and Ryu: Scleral Perforation During Inferior Rectus Muscle Recession in Congenital Fibrosis of the Extraocular Muscles

Case Report

J Korean Ophthalmol Soc 2016;57(3):524-527.

Published online: 3 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.3.524

Scleral Perforation During Inferior Rectus Muscle Recession in Congenital Fibrosis of the Extraocular Muscles

Woo Seok Choi, MD, Yoon Hyung Kwon, MD, Won Yeol Ryu, MD

Department of Ophthalmology, Dong-A University College of Medicine, Busan, Korea

Address reprint requests to Won Yeol Ryu, MD, Department of Ophthalmology, Dong-A University Hospital, #26 Daesingongwon-ro, Seo-gu, Busan 49201, Korea, Tel: 82-51-240-2737, Fax: 82-51-254-1987, E-mail: wyryu@dau.ac.kr

Received 30 July 2015 Revised 4 December 2015 Accepted 16 January 2016

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

We report a case of a scleral perforation during inferior rectus recession in congenital fibrosis of extraocular muscles and the management of this perforation with a scleral patch graft.

Case summary

A 20-month-old female with bilateral ptosis, absence of elevation and a chin-up position was diagnosed with congenital fibrosis of extraocular muscles. Because severe esotropia in the downward gaze was observed, we first performed esotropia surgery. After 1 year, she underwent a bilateral ptosis correction. We decided to perform bilateral inferior rectus recession due to an abnormal head posture and the absence of elevation. Because the inferior rectus muscles were extremely tight and adhered to the sclera, hooking and isolating these muscles during surgery was difficult. After muscle suture placement, a portion of the sclera that contacted the left inferior rectus was chipped off as this muscle was disinserted with blunt Westcott scissors. A scleral perforation was observed, thus, we placed a scleral patch graft using the donor sclera and finished the bilateral inferior rectus recession. No abnormal findings for the vitreous or retina were detected. At 8 months after surgery, the patient exhibited exotropia of 12 prism diopters in her primary gaze. Her abnormal head posture nearly disappeared.

Conclusions

Careful isolation and disinsertion of the muscle from the globe is necessary in the treatment of patients who are expected to exhibit severe adhesions between the muscle and sclera, such as patients with congenital fibrosis of extraocular muscles.

Keywords: Complication of strabismus surgery, Congenital fibrosis of extraocular muscles, Congenital fibrosis syndrome, Scleral perforation

References

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Figure 1.

The clinical manifestation and intraoperative findings. (A) Eye movement prior to bilateral inferior rectus muscle recession. The patient exhibits downward eye fixation, an absence of elevation and limited abduction in the left eye. (B) A scleral perforation with uveal prolapse is observed (3 × 3 mm). (C) A scleral patch graft is immediately placed.

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