Combined Recession–Resection of The Superior Rectus Muscle in the Treatment of Dissociated Vertical Deviation.

Purpose This is retrospective study that evaluates the use of combined recession-resection of the superior rectus muscle in the treatment of dissociated vertical deviation (DVD) Methods The medical records of 21 patients with bilateral DVD were retrospectively reviewed. Preoperative data were extracted for age, gender, BCVA (logMAR), amblyopia, angle of stereopsis, previous strabismus surgeries and angle of deviation. All included patients received resection of 2.5 mm of the superior rectus muscle prior to its recession in an amount determined by the maximum DVD angle. The main outcome measure was postoperative angle of DVD at the end of six postoperative months and success was identified as absence of manifest DVD . Results The mean angle of preoperative DVD was 18.09 PD in the right eye and 16.76 PD in the left ‎eye‎. The mean amount of SR recession was 8.9 ‎±1.4 ‎mm in the right e‎‎ye and 8.7 ‎±1.5 in the left ‎eye with symmetrical surgery performed in only 7 patients. Mean postoperative angle of DVD was ‎5.96‎ in the right eye and ‎5.86 ‎in the left eye. Surgical success was achieved in 15 patients (71%). Conclusions Combined recession-resection of the superior rectus muscle seems to be an effective technique in the management of DVD and could represent a good alternative to other surgical procedures.

AN UNSUSUAL CASE OF ISOLATED EXTRAOCULAR MYOCYSTICERCOSIS: MASQUERADING AS A SUPERIOR RECTUS MUSCLE ABSCESS

Human cysticercosis is caused by the larval form of the swine tapeworm Taenia solium.It can affect the central nervous system, the eye, skeletal muscles and subcutaneous tissues. In the orbit, cysticercosis can lodge into any extraocular muscle or other adnexal structures and are usually found as part of a generalized systemic infestation and very rarely seen with isolated infestation of a single extraocular muscle.Hence, sometimes as it was in our case,it is very difficult to differentiate an isolated extraocular muscle cysticercosis from extraocular muscle abscess or lymphoma. So,we, at our institute report a rare and unusual case of isolated right superior rectus muscle cysticercosis which presented with ptosis and painless swelling of the right upper eyelid, which was in fact discovered later masquerading as a superior rectus abscess.

Augmented superior rectus muscle transposition in management of defective ocular abduction

Background Superior rectus muscle transposition (SRT) is one of the proposed transposition techniques in the management of defective ocular abduction secondary to chronic sixth nerve palsy and esotropic Duane retraction syndrome (Eso-DRS). The aim of the current study is to report the outcomes of augmented SRT in treatment of Eso-DRS and chronic sixth nerve palsy. Methods a retrospective review of medical records of patients with Eso-DRS and complete chronic sixth nerve palsy who were treated by augmented full tendon SRT combined with medial rectus recession (MRc) when intraoperative forced duction test yielded a significant contracture. Effect on primary position esotropia (ET), abnormal head posture (AHP), limitation of ocular ductions as well as complications were reported and analyzed. Results a total of 21 patients were identified: 10 patients with 6th nerve palsy and 11 patients with Eso-DRS. In both groups, SRT was combined with ipsilateral MRc in 18 cases. ET, AHP and limited abduction were improved by means of 33.8PD, 26.5°, and 2.6 units in 6th nerve palsy group and by 31.1PD, 28.6°, and 2 units in Eso-DRS group respectively. Surgical success which was defined as within 10 PD of horizontal orthotropia and within 4 PD of vertical orthotropia was achieved in 15 cases (71.4%). Significant induced hypertropia of more than 4 PD was reported in 3 patients (30%) and in 2 patients (18%) in both groups, respectively. Conclusion augmented SRT with or without MRc is an effective tool for management of ET, AHP and limited abduction secondary to sixth nerve palsy and Eso-DRS. However, this form of augmented superior rectus muscle transposition could result in high rates of induced vertical deviation.

A prospective, randomised study of the effect of fixation sutures during phacotrabeculectomy on intraocular pressure and incidence of ptosis

We investigated the effects of different intraoperative eyeball fixation techniques (superior rectus muscle suture [MS] and traction suture at the corneal limbus [CS]), on intraocular pressure (IOP) and the incidence of ptosis after phacotrabeculectomy. Forty-one eyes with different glaucoma types which qualified for phacotrabeculectomy were included. Twenty-three and eighteen patients were included in the CS and MS groups, respectively. The IOP, best-corrected visual acuity (BCVA), and margin reflex distance were assessed preoperatively and 3, 6, and 12 months post-operatively. Preoperatively, the mean IOPs (± standard deviation) in the CS and MS groups were 23.6 ± 7.3 mmHg and 24.3 ± 6.6 mmHg (p > 0.05), respectively. At 3 and 6 months post-surgery, the mean IOPs were significantly lower in the CS group than in the MS group: 13.9 ± 3.0 mmHg vs. 17.7 ± 3.5 mmHg (p = 0.001), and 13.9 ± 4.9 mmHg vs. 17.2 ± 3.5 mmHg (p = 0.005), respectively (mean difference: 3.9, 95% confidence interval 1.7–6.1). At 12 months, the mean postoperative IOPs were 15.2 ± 3.5 mmHg and 14.9 ± 3.6 mmHg in the CS and MS groups, respectively (p > 0.05). At 6 months, the BCVAs were 0.91 ± 0.15 and 0.71 ± 0.3 (p = 0.029) in the CS and MS groups, respectively; BCVAs were 0.91 ± 0.15 and 0.71 ± 0.3 (p = 0.029) in the CS and MS groups, respectively; the difference was non-significant 12 months post-surgery (0.78 ± 0.32 vs. 0.74 ± 0.30, p = 0.553). Postoperative ptosis was observed in 4 (17%) and zero patients in the CS and MS groups, respectively, but the difference was not statistically significant (p = 0.118). The study was not powered sufficiently to detect statistically significant changes in exploratory endpoints. The study was not powered sufficiently to detect statistically significant differences between groups in exploratory endpoints.

An Uncommon Case of Isolated Superior Rectus Palsy

Head injury associated with orbital trauma is commonly encountered in day-to-day practice. We report a rare case of orbital trauma resulting in isolated orbital “roof blow” in fracture in a 14-year-old child. The patient presented to us with diplopia and limitation of elevation of right eye after orbital trauma. Computed tomography of the orbits (2 mm sections) did not reveal fracture of the orbital floor. However, there was orbital roof “blow in” fracture with fracture fragment impingement on the superior rectus muscle. Patient was treated conservatively and spontaneous recovery of ocular motility was noted after a month.

Comparison of the Superior and Inferior Rectus Muscles in Humans: An Anatomical Study with Notes on Morphology, Anatomical Variations, and Intramuscular Innervation Patterns

A comparison of the superior and inferior rectus muscles was performed to determine whether they have similar structures and innervation attributable to their participation in the same type of, although antagonistic, eye movements. The study was conducted on 70 cadaveric hemiheads, and the anatomical variations in the superior and inferior rectus muscles were assessed. Sihler’s whole mount nerve staining technique was used on 20 isolated superior and 20 isolated inferior rectus muscle specimens to visualize the intramuscular distribution of the oculomotor nerve subbranches. In two cases (~2.8%), variant muscular slips were found that connected the superior and inferior rectus muscles. In 80% of cases, muscular branches arising directly from the inferior branch of the oculomotor nerve innervated the inferior rectus muscle, while in 20% of cases, the nerve to the inferior oblique muscle pierced the inferior rectus muscle and provided its innervation. In 15 of 70 specimens (21.4%), a branch to the levator palpebrae superioris muscle pierced the superior rectus muscle. The distance between the specific rectus muscle’s insertion and the anterior-most terminations of the nerves’ subbranches with reference to the muscle’s total length ranged from 26.9% to 47.2% for the inferior rectus and from 34.8% to 46.6% for the superior rectus, respectively. The superior rectus muscle is slightly longer and its insertion is farther from the limbus of the cornea than is the inferior rectus muscle. Both muscles share a common general pattern of intramuscular nerve subbranches’ arborization, with characteristic Y-shaped ramifications that form the terminal nerve plexus located near half of the muscles’ length. Unexpected anatomical variations of the extraocular muscles may be relevant during orbital imaging or surgical procedures.

Detailed Anatomy of the Lateral Rectus Muscle-Superior Rectus Muscle Band

Background. To elucidate the detailed anatomy of the lateral rectus muscle-superior rectus muscle (LR-SR) band by cadaver eye investigation. Methods. In total, 48 eyes of 24 cadavers were observed macroscopically. The lateral rectus muscle (LRM) and superior rectus muscle (SRM) were dissected from their origins to their insertions under the dissecting microscope, and the location, width, length, and tensile strength of the LR-SR bands were measured. Results. The LR-SR band is the thick ligament interconnecting LRM pulleys with SRM pulleys. The LR-SR band was covered by the orbital part of the lacrimal gland superiorly, and the intermuscular septum between the LRM and SRM was shown anterior to the LR-SR band. The length of the attachment site between the LR-SR band and the SRM was less at 8.64 ± 1.52 mm (p=0.040), its thickness was thinner at 0.74 ± 0.16 mm (p=0.002), and its tensile strength was weaker at 7.64 ± 1.82 N (p=0.028) compared to the attachment site between the LR-SR band and the LRM. Conclusions. This study revealed the detailed anatomy of the LR-SR band and provided helpful information to understand heavy eye syndrome and sagging eye syndrome.