Dataset Information

Extraocular Rectus Muscle Stretching as a Weakening Procedure.

ABSTRACT:

Introduction

Anterior segment ischemia may occur when three or more rectus muscles are operated in the same eye. Our purpose was to investigate the efficacy of rectus muscle stretching as a vessel-sparing weakening technique, in comparison with a retrospectively collected series of patients.

Methods

Non-operated patients with an indication of medial rectus muscle weakening surgery (deviation up to 20 PD, prism diopters) who could cooperate with topical or sub-Tenon's anesthesia. Clinical workup included routine complete ophthalmological evaluation. One double-needle 6/0 Mersilene suture was used on each side of the muscle at 4 mm distance of the insertion and pulled/stretched to insert in the sclera 3-5 mm posterior to the muscle locking passes. Main outcome measure was distance deviation at 2 months after surgery (alternate prism and cover test).

Results

Seven patients with esotropia of 12-20 PD, recruited in a 20-month period, were included. Preoperative median deviation was 20 PD, whereas postoperative median deviation was 4 PD (range 0-8 PD). On a visual pain scale (1-10) median pain score was 3 (range 2-5). Remarkable postoperative complications did not occur. Significant differences with a retrospectively collected series of patients' data, treated with standard medial rectus recession, were not observed.

Conclusions

Preliminary data indicate that stretching of a rectus muscle has some weakening effect, that could be useful to correct small-angle strabismus, and may be suggested as a vessel-sparing technique when two rectus muscles have previously been operated in the same eye.

Trial registration

ClinicalTrials.gov NCT05778565.

SUBMITTER: Tejedor J

PROVIDER: S-EPMC10441879 | biostudies-literature | 2023 Oct

REPOSITORIES: biostudies-literature

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Publications

Extraocular Rectus Muscle Stretching as a Weakening Procedure.

Tejedor Jaime J Gutiérrez-Carmona Francisco J FJ

Ophthalmology and therapy 20230701 5

<h4>Introduction</h4>Anterior segment ischemia may occur when three or more rectus muscles are operated in the same eye. Our purpose was to investigate the efficacy of rectus muscle stretching as a vessel-sparing weakening technique, in comparison with a retrospectively collected series of patients.<h4>Methods</h4>Non-operated patients with an indication of medial rectus muscle weakening surgery (deviation up to 20 PD, prism diopters) who could cooperate with topical or sub-Tenon's anesthesia. C ...[more]

PMID: 37392274

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Project description:Each rectus extraocular muscle in cetaceans divides into two portions: a massive palpebral belly that inserts into the deep surface of the eyelids and a smaller scleral belly that inserts onto the eyeball. While the cetacean palpebral insertions have long been recognized, their homologies and functions remain unclear. To compare cetacean rectus EOM insertions with the global and orbital rectus EOM insertions of other mammals we dissected orbital contents of 20 odontocete species, 2 mysticete species and 18 non-cetacean species, both aquatic and terrestrial. Four cetacean species were also examined with magnetic resonance imaging (MRI). All four rectus muscles in cetaceans had well-developed palpebral bellies and insertions. Adjacent palpebral bellies showed varying degrees of fusion, from near independence to near complete fusion. Fusion was most complete towards palpebral insertions and less towards origins. A medial moiety of the superior rectus palpebral belly is likely the levator palpebrae superioris. Smaller but still robust scleral insertions were present on all recti, with the medial rectus (MR) being significantly more muscular than the others. All non-cetacean species examined had recti with distinct global and orbital insertions, the latter generally onto Tenon's capsule. Orbital insertions in pygmy hippopotamus and Florida manatee extended into the deep surfaces of the eyelids, hence qualifying as palpebral insertions. Our results suggest that rectus EOMs of mammals generally have both global and orbital insertions, and that palpebral bellies of cetaceans and other species are modified homologs of the orbital insertions. The presence of palpebral insertions in pygmy hippopotamus and absence in other cetartiodactyls suggests an intermediate condition between terrestrial cetartiodactyls and cetaceans. Palpebral insertions in Florida manatee and reports of their presence in some pinnipeds suggest parallel evolution in multiple aquatic lineages. Various functions of cetacean palpebral recti have been proposed, including eyelid dilators, protection during diving and thermogenesis for warming eye and brain. For further insight into their possible functions, we observed eye movements of captive bottlenose dolphins (Tursiops truncatus) at the U.S. National Aquarium. Our observations showed that in addition to rotation of the eyeball the entire surrounding palpebral region also moves during gaze changes. For example during upward gaze the globe not only rotates in supraduction but translates dorsally as well. It appears the rectus palpebral bellies are responsible for flexing the palpebral structures and thus also translating the globe, while the scleral insertions act directly for ocular rotation. Along with frequent non-conjugate eye movements, the oculomotor mechanics and repertoire of cetaceans are thus quite distinctive. Summarily, axial displacement within the orbit is a major 'eye movement' in cetaceans, with protrusion and retraction mediated by well-developed circular muscles and retractor bulbi respectively. Torsional eye movements driven by elaborate oblique EOMs are likewise significant. The roles of rectus EOMs for ocular rotation via their scleral insertions, especially the highly muscular MR, are for typical supra/infraductions and nasal/temporal ductions. The palpebral bellies accentuate these ductions by translating the globe and surrounding structures in the same direction.

Dataset Information

Extraocular Rectus Muscle Stretching as a Weakening Procedure.

Introduction

Methods

Results

Conclusions

Trial registration

Publications

Extraocular Rectus Muscle Stretching as a Weakening Procedure.

Similar Datasets

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