Journal List > J Korean Ophthalmol Soc > v.60(12) > 1139592

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Noh, Park, and Oh: Long-term Outcome of a Muscle Union Procedure in Patients with Horizontal Paralytic Strabismus
Original Article

Journal of the Korean Ophthalmological Society 2019; 60(12): 1269-1274.

Published online: 17 December 2019

DOI: https://doi.org/10.3341/jkos.2019.60.12.1269

Long-term Outcome of a Muscle Union Procedure in Patients with Horizontal Paralytic Strabismus

Hoon Noh, MD, Kyung-Ah Park, MD, Sei Yeul Oh, MD

Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Address reprint requests to Kyung-Ah Park, MD Department of Ophthalmology, Samsung Medical Center, #81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea. Tel: 82-2-3410-3562, Fax: 82-2-3410-0074, lethe22@hanmail.net

Received 16 May 2019       Revised 26 June 2019       Accepted 6 December 2019

©2019 The Korean Ophthalmological Society

The Korean Ophthalmological Society

(open-access):

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 report the long-term surgical outcomes of a muscle union procedure in patients with paralytic strabismus.

Methods

We retrospectively reviewed the medical records of 20 patients who underwent muscle union procedure for paralytic strabismus from September 2010 to March 2018. We analyzed the clinical results before and at the final visit after surgery. We also compared the outcomes of the first year after surgery between patients with sixth cranial nerve palsy, with third cranial nerve palsy and with medial rectus muscle rupture after endoscopic sinus surgery.

Results

The mean follow-up duration was 42 ± 20 months (12–79 months). The mean age at surgery was 40 ± 19 years (7–65 years). Eleven patients underwent surgery for sixth cranial nerve palsy, six patients underwent surgery for third cranial nerve palsy, and three patients underwent surgery for medial rectus rupture after endoscopic sinus surgery. The mean horizontal deviation at the primary eye position was 58 ± 19 prism diopters before surgery and decreased to 14 ± 17 prism diopters at the final visit. The success rate at the last visit was 60%. The mean horizontal deviation at postoperative 1 year was 4 ± 9 prism diopters in the sixth nerve palsy group and 26 ± 16 prism diopters in the third nerve palsy group (p = 0.002). The success rate was 91% in the sixth nerve palsy group and 33% in the third nerve palsy group at postoperative 1 year (p = 0.017). There were no complications during surgery or anterior segment ischemia for any of the patients.

Conclusions

A muscle union procedure had good long-term surgical outcomes in patients with paralytic strabismus, especially in patients with sixth cranial nerve palsy. However, in the case of third cranial nerve palsy or rupture of the medial rectus muscle, the effects were limited.

Keywords: Muscle transposition, Muscle union procedure, Sixth cranial nerve palsy, Third cranial nerve palsy

Figures and Tables

Figure 1

A 38-year-old woman with an acquired left sixth nerve palsy due to a brain tumor. Before (top) and 18 months after (bottom) the muscle union procedure and medial rectus recession of 9 mm in the left eye.

jkos-60-1269-g001
Figure 2

A 62-year-old man with a medial rectus rupture after sinus surgery. Before (top) and 14 months after (bottom) the muscle union procedure and lateral rectus recession of 9 mm in the right eye.

jkos-60-1269-g002
Table 1

Preoperative characteristics of patients with paralytic strabismus who underwent the muscle union procedure

jkos-60-1269-i001

Values are presented as mean ± standard deviation (range) or number (%).

PD = prism diopters.

*Voluntary ductions were performed using a 4-point scale ranging from 0 to −4: 0 = patient has full movement; −1 = 75% of normal range; −2 = 50% to less than 75% of normal range; −3 = 25% to less than 50% of normal range; and −4 = 0% to less than 25% of normal range.

Table 2

Preoperative and postoperative data of the patients who underwent the muscle union procedure for paralytic strabismus

jkos-60-1269-i002

Values are presented as mean ± standard deviation or number (%).

PD = prism diopters.

*Comparison between the sixth nerve palsy group and the third nerve palsy group; †comparison between the third nerve palsy group and the medial rectus palsy group; ‡Mann-Whitney U-test; §Fisher's exact test.

Notes

Conflicts of Interest The authors have no conflicts to disclose.

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