Vertical rectus muscle transposition for bilateral Duane syndrome.

BACKGROUND: Augmented transposition of the superior and inferior rectus muscles to the lateral rectus muscle is effective surgical treatment for esotropia in unilateral Duane syndrome. Medial rectus muscle recession in bilateral Duane syndrome may increase the risk of consecutive exotropia and cause limitation to adduction postoperatively. Vertical rectus muscle transposition may be useful in bilateral Duane syndrome with esotropia. METHODS: We undertook a retrospective review of 11 patients with bilateral Duane syndrome and esotropia in primary position. All patients had vertical rectus muscle transpositions. Six patients had unilateral vertical rectus transpositions (2 eyes with and 4 without suture augmentation). Twelve eyes from 7 children (2 unilateral and 5 bilateral) had transpositions augmented with posterior fixation sutures. Posterior fixation suture were added to large deviations in patients without prior medial rectus recessions. RESULTS: The preoperative esotropia at distance was 22.8 +/- 6.3 prism diopters (PD). It reduced to 2.0 +/- 6.7 PD postoperatively. (P < 0.001) Esotropia at near changed from 21.0 +/- 5.8 PD preoperatively to 1.2 +/- 8.1 PD postoperatively. (P < 0.001) One patient with a 10-degree face turn had complete resolution postoperatively. One patient had a small undercorrection and developed a vertical deviation requiring additional surgery. All patients had improvement in abduction. Nine of 11 patients did not develop any limitation to adduction. One patient developed a -1 adduction deficit 5 years later. Three patients achieved fusion with a mean stereovision of 67 seconds of arc (range, 80-40 seconds.). Follow-up averaged 22.2 months (range, 1-100 months). CONCLUSION: Vertical rectus muscle transposition in patients with bilateral Duane syndrome and esotropia is an effective procedure to improve ocular alignment and motility while preserving adduction.     

Four-muscle surgery for infantile esotropia with V-pattern

Inferior oblique overaction is frequently seen with infantile esotropia. In patients with infantile esotropia and V-pattern with moderate to large inferior oblique overactions, the oblique weakening can be combined with horizontal muscle surgery. Eighteen patients with infantile esotropia and V-pattern underwent bilateral inferior oblique recessions with bilateral 5.0-mm medial rectus recessions. Sixty-one patients with infantile esotropia underwent bilateral 5.0-mm medial rectus recessions alone. At 2 years' follow-up, the patients who had undergone medial rectus recessions alone showed, on average, 12.9 dioptres more reduction in esodeviation at distance and 13.4 dioptres more reduction at near in primary position than did those who had undergone 4-muscle surgery (P = 0.03). Only 2 of the 18 patients (11%) who had undergone 4-muscle surgery developed an A-pattern postoperatively.     

Unilateral recession and resection in Duane syndrome.

PURPOSE: To assess the efficacy of lateral rectus resection with medial rectus recession in the affected eye of patients with Duane retraction syndrome (DRS) with esotropia and limited abduction, compared with bilateral medial rectus recessions. METHODS: The charts of 9 patients with DRS who underwent a recession-resection procedure and 10 patients with DRS who underwent bilateral medial rectus recessions were reviewed. Ocular ductions (graded from 0 = full duction to -4 = total deficit), severity of retraction, alignment, head position, and binocular single vision field (for study group only) were recorded before and after surgery. RESULTS: Before surgery, the study and control groups did not differ in mean primary position esotropia (16.9 and 18.8 PD, respectively), face turn (16.5 degrees and 15.0 degrees, respectively), average limitation of abduction (-3.9 and -3.7, respectively), or adduction (-0.1 and -0.3, respectively). After surgery, both groups had similar mean face turns (3.9 degrees and 1.0 degrees ), esotropia (3.3 PD and 1.0 PD), and abduction limitation in the affected eye (-2.4 and -2.6). However, mean adduction was significantly worse in the control group than in the study group (-1.5 vs -0.6, P = .02). Globe retraction improved in all control subjects. It worsened in 5 study subjects and did not improve in the other 4. In the study group, 1 patient required reoperation for undercorrection and another was overcorrected. CONCLUSION: Seven of 9 patients with DRS, selected on the basis of esotropia, limited abduction, and mild retraction, benefited from a recession-resection procedure. Abduction improved to the same degree as seen after bilateral medial rectus recessions, with less tendency to limit adduction.     

Difficulties in diagnosis and treatment of dissociated vertical deviation (DVD). Part II--own experiences

Oblique muscles motility disorders may influence the magnitude of dissociated vertical deviation (DVD), resulting in greater vertical deviation in abduction and smaller in adduction. The diagnosis of this pattern of dissociation is essential for the selection of appropriate surgical management. PURPOSE: The aim of this study was to assess optimal diagnostic and treatment procedures in patients with incomitant dissociated vertical deviation, superior oblique overaction and esotropia. PATIENTS AND METHODS: Five patients with the constellation of esotropia, bilateral superior oblique overaction, A-pattern, and incomitant dissociated vertical deviation are presented. In each case the magnitude of vertical deviation was greater in abduction and minimal or absent in adduction. Four patients underwent asymmetric bilateral superior rectus recessions and partial tenotomy of the posterior and middle fibers of superior oblique tendons. In one case additional surgery of horizontal muscles was performed. RESULTS: In all cases the A-pattern, DVD was markedly reduced or eliminated, and comitancy was achieved. CONCLUSION: Recognition of the described pattern is important in selecting appropriate surgical management. Asymmetric bilateral superior rectus recessions and partial tenotomy of the posterior and middle fibers of superior oblique tendons is useful in reducing the A-pattern and incommitancy in DVD.     

Long-term outcomes of strabismus surgery in Mobius sequence

ABSTRACT

Purpose: Mobius sequence is a rare disorder that results from underdevelopment of the sixth and seventh cranial nerves, with subsequent facial weakness and impairment of ocular abduction. Approximately half of the affected patients have esotropia with limitation of extraocular movements. This study retrospectively reviews the long-term outcome of strabismus surgery for such patients.

Methods: The long-term follow-up results in five children with Mobius sequence, who were observed after strabismus surgery for congenital esotropia, were analyzed.

Results: All patients had a limitation of abduction in both eyes. Preoperative esotropia ranged from 20 to 30 prism diopters (PD) (mean 27 PD). Patient age at surgery ranged from 4.5 to 14 months. Bilateral medial rectus muscle recession was performed in all cases, ranging from 4.0 to 6.5 mm. Inferior transposition of the medial rectus muscles was performed in two patients for treatment of V-pattern, and two patients also had surgery for vertical strabismus. Follow-up ranged from 4 to 19.5 years (mean 11.7 years). The final horizontal alignment was <8 PD in all patients, and all demonstrated some binocularity.

Conclusion: Bilateral medial rectus muscle recession is an effective treatment for esotropia associated with Mobius sequence, with good long-term stability.     

Anterior and nasal transposition of the inferior oblique muscles in patients with missing superior oblique tendons.

INTRODUCTION: Patients with missing superior oblique (SO) tendons present with overelevation/underdepression in adduction. Unilateral cases often exhibit abnormal head postures, whereas in bilateral cases, there may be a marked V-pattern with upgaze exotropia. These patients may have craniosynostosis. METHODS: Nine children with unilateral (n = 2) or bilateral (n = 7) absent SO tendons underwent anterior and nasal transposition of the inferior oblique (IO) muscles, some in combination with horizontal rectus recession for horizontal strabismus. They were evaluated 6 to 46 months postoperatively for alignment and oculomotor examination. Cyclodeviations were not evaluated in most children. RESULTS: Postoperatively, all patients improved. Both unilateral cases were orthotropic with no abnormal head posture. In the bilateral cases, vertical deviation in adduction and exotropia in upgaze had largely cleared, although some symptoms remained, most notably vertical deviation in side gaze (3 patients) and V-pattern esotropia in downgaze (2 patients). A patient missing both SO tendons as well as the left superior rectus muscle, who had the anterior and nasal transposition on the right side only, remained with 25(Delta) left hypotropia. CONCLUSIONS: Anterior and nasal transposition of the IO muscle reduces overelevation in adduction and helps eliminate or reduce divergence of the eyes in upgaze, but esodeviation may persist in downgaze. This procedure was most effective in unilateral absence of the SO tendon. It is likely to benefit patients with severe congenital fourth nerve palsy in which standard IO muscle weakening procedures have been ineffective.     

Traumatic Superior Oblique Palsies

The differences in the clinical and diagnostic characteristics of 33 consecutive traumatic unilateral (21 patients, 62% ) and bilateral (12 patients, 38%) superior oblique palsies were studied. The unilateral palsies had a large hypertropia in primary postion, more vertical than torsional diplopia, a compensatory head tilt to obtain fusion, and a positive Bielschowsky head tilt test. In contrast, the bilateral palsies had small hypertropias in primary gaze that alternated on right and left gaze, a large V-pattern esotropia with excyclotorsion that was frequently bilateral, and a compensatory head position with fusion in upgaze. The results of the study indicate that a V-pattern in excess of 25 prism diopters, an excyclotorsion of greater than 10 degrees, or head trauma severe enough to cause loss of consciousness should also signal bilateral involvement. Torsional diplopia was present in only 20% of unilateral palsies vs 75% of bilateral palsies. The Bielschowsky head tilt test was diagnostic in 100% of the patients with unilateral palsy and 83% of the patients with bilateral palsy. It was undiagnostic in the supine position in all patients. Spontaneous resolution occurred in 65% of the unilateral palsies but in only 25% of the bilateral palsies. Surgical correction was successful in relieving persistent symptoms.     

Superior Oblique Tucks for Apparent Inferior Oblique Overaction and V-pattern Strabismus Associated with Craniosynostosis

Introduction: Apparent inferior oblique overaction and apparent superior oblique underaction are common in strabismus associated with craniosynostosis, and in many cases are likely due to excyclotorsion of the globes, with the rectus muscles acting with oblique vectors. We present a patient with craniosynostosis who underwent bilateral superior oblique tucks to specifically address the excyclotorsion of the globes.

Methods: A 16-year-old male with Saethre-Chotzen syndrome presented with apparent bilateral inferior oblique overaction and apparent bilateral superior oblique underaction. He had 30 prism diopter (PD) esotropia and 5 PD left hypertropia by simultaneous prism and cover test (SPCT) at distance and near fixation. Fundus exam revealed marked excyclotorsion of both globes. The superior oblique tendons were tucked 10?mm bilaterally, using a 6-0 mersilene suture and the medial rectus muscles were recessed 5.5?mm on an adjustable suture with a 10-mm inferior displacement. Surgical results were reviewed at 6 weeks and 2 years postoperatively.

Results: At 6 weeks and 2 years postoperatively, apparent inferior oblique overaction, apparent superior oblique underaction, and V-pattern esotropia were markedly improved. At 2 years, SPCT measurements were 8 PD esotropia in primary position at distance and 4 PD esotropia and 3 PD left dissociated vertical deviation at near.

Conclusions: Bilateral superior oblique tucks are useful in addressing the excyclotorsion that leads to apparent inferior oblique overaction and V-pattern strabismus associated with craniosynostosis.     

Proceedings of the 8th Annual Meeting of the Bielschowsky Gesellschaft,Regensburg, Germany,July 6th to 8th 2001

Fifty-two children with infantile esotropia had surgery for their esotropia between two and seven years of age. Another 49 had similar surgery before the age of two years. Of these 101 operated children, the esotropia in 70 patients was aligned to within 10 prism diopters. The patients with successful alignment were reviewed to study the effect of early versus late surgical intervention of their deviation, i.e. before and after two years of age. The motor and sensory states of the selected patients were analysed before and after surgical correction. The choice and number of surgical procedures employed are discussed. It appears that patients two years and older when strabismus was surgically corrected have a good chance of alignment, but less chance of attaining binocularity. In many cases there was a V-pat-tern esotropia, requiring surgery on the overacting inferior oblique muscles. In comparison, the younger group with earlier surgery appeared to show a better chance of attaining binocularity and fewer patients had significant V-pattern requiring surgery on the inferior oblique muscles.     

Early versus late alignment of infantile esotropia

Fifty-two children with infantile esotropia had surgery for their esotropia between two and seven years of age. Another 49 had similar surgery before the age of two years. Of these 101 operated children, the esotropia in 70 patients was aligned to within 10 prism diopters. The patients with successful alignment were reviewed to study the effect of early versus late surgical intervention of their deviation, i.e. before and after two years of age. The motor and sensory states of the selected patients were analysed before and after surgical correction. The choice and number of surgical procedures employed are discussed. It appears that patients two years and older when strabismus was surgically corrected have a good chance of alignment, but less chance of attaining binocularity. In many cases there was a V-pat-tern esotropia, requiring surgery on the overacting inferior oblique muscles. In comparison, the younger group with earlier surgery appeared to show a better chance of attaining binocularity and fewer patients had significant V-pattern requiring surgery on the inferior oblique muscles.     

Maximum motor fusion combined with one-hour preoperative prism adaptation test in patients with acquired esotropia

PURPOSE: Preoperative prism adaptation and the maximum motor fusion test reduce the risk of postoperative undercorrection, overcorrection, and bifocal requirements in acquired esotropia. The purpose of our study is to determine the efficacy of the maximum motor fusion test followed by a short prism adaptation test in patients with acquired esotropia undergoing bilateral medial rectus muscle recession. METHODS: We undertook a retrospective review of 29 subjects with acquired esotropia without history of amblyopia, previous strabismus surgery, use of bifocals, pattern anisotropia, dissociated vertical deviation, or oblique muscle dysfunction. All subjects underwent bilateral medial rectus muscle recessions based on the distance angle of deviation measured with the maximum motor fusion test followed by prism adaptation test. Alternate prism and cover testing was performed after 1 hour of prism adaptation to determine the angle of deviation for surgical correction. RESULTS: The age at surgery was 4.5 +/- 1 years. The preoperative angle of deviation at distance was 20.4 +/- 4.2(delta). It increased to 36.2 +/- 4.2(delta) after the maximum motor fusion test followed by 1 hour of prism adaptation testing. The final preoperative angle of deviation post motor fusion test-prism adaptation test was significantly larger than the initial angle of deviation (p < 0.0001). The final postoperative deviation at distance was 1.3 +/- 3.3(delta), and 5.2 +/- 1.5(delta) at near. Postoperative follow up was 18 +/- 2.6 months (range, 13-24 months). CONCLUSIONS: The combination of maximum motor fusion and preoperative prism adaptation allowed increased amounts of medial rectus muscle muscle recession, decreasing the risk of postoperative undercorrection without increasing the risk of overcorrection.     

Consecutive exotropia following strabismus surgery

We investigated the clinical factors affecting the development of consecutive exotropia following esotropia surgery. The development period of consecutive exotropia, amblyopia and limitation of adduction were evaluated in 89 patients with primary esotropia that changed to consecutive exotropia after surgery. In the presence of deep amblyopia, consecutive exotropia developed earlier. When two horizontal muscles were operated, limitation of adduction was more frequent in symmetrical rather than asymmetrical surgical procedure. Since consecutive exotropia may develop many years after esotropia surgery, a long-term follow-up period in patients without consecutive exotropia in the early postoperative period is advised.     

周期性内斜视手术前后双眼视觉及手术时机的探讨

目的 观察和分析周期性内斜视手术前、后双眼视觉及其手术时机的选择.方法 将30例4～21岁符合标准的内斜视分为2组:周期性内斜视者14例;恒定性内斜视(初诊时为周期性内斜视)16例.同视机测定远双眼视觉级别,颜少明<立体视觉检查图>测定近立体视锐度.观察术前、术后的远双眼视觉,近立体视锐度变化.结果 14例周期性内斜视患者术前正位日及术后远双眼视觉及近立体视锐度与正常人群相比无显著性差异.16例恒定性内斜视(初诊时为周期性内斜视)术前12例(75%)无双眼视觉,术后16例(100%)具有同时知觉能力,16例(100%)可获得融合力,但融合范围低于正常人群.10例(62.5%)获远立体视,8例(50%)获得不同程度近立体视.结论 周期性内斜视应尽量在周期性期间手术,有利于双眼单视功能的恢复,达到功能治愈的目的 .     

The maximum motor fusion test: a parameter for surgery for acquired esotropia.

PURPOSE: The purpose of this study was to determine whether surgery for acquired esotropia based on the maximum capacity for motor fusion measured with a prism bar could be used to increase the number of millimeters of bilateral medial rectus recession that could be performed without producing an early overcorrection or a late consecutive exotropia, as a way safely to reduce the need for postoperative wear of glasses or a bifocal. METHODS: Category I patients had residual deviations of esotropia (ET) of 12 PD or more with distance fixation, measured after a full hyperopic correction of +1.50 to +3.25 was placed, and had no significant anisometropia or astigmatism. Category II patients had residual deviations of esotropia of less than 11 PD with distance fixation and had residual deviations of esotropia with near fixation (ET') of at least 10 PD more than esotropia with distance fixation ("clinical high AC/A"). Category III patients had had previous bilateral medial rectus muscle recessions and had recurrent esotropia with near fixation of more than 10 PD. For patients in categories I and II, bilateral medial rectus muscle recessions were performed by using a published dose-response table from the national Prism Adaptation Study but with the maximum capacity for motor fusion as the input parameter instead of the prism-adapted angle. Patients in category III received re-recessions of one or both medial rectus muscles, according to a previously published system, with the distance fusional amplitude as the input parameter. RESULTS: In category I, 24 of 30 (80%) patients needed no glasses after surgery, 1 of 30 had esotropia, and 2 of 30 had exotropia (XT) (10% reoperation rate). In category II, 35 of 36 (98%) patients needed no bifocals after surgery, and 3 of 36 had exotropia (9% reoperation rate). In category III, 10 of 10 patients needed no bifocals, and 2 of 10 had exotropia (20% reoperation rate). CONCLUSIONS: When a postoperative reduction in dependence on continuous wear of an optical appliance is a reasonable goal, the maximum motor fusional capacity, measured with a prism bar, is a good parameter for surgical design.     

Preoperative prism adaptation in acquired esotropia with convergence excess.

PURPOSE: The prism adaptation test (PAT) is used preoperatively to determine the surgical target angle for acquired esotropia. We assessed the surgical outcomes for children with convergence-excess esotropia (near esotropia greater than distance esotropia by 10 prism diopters [PD] or more) whose target angle was based on the results of the PAT geared to the near deviation. METHODS: We reviewed the charts for all of one surgeon's patients who underwent the PAT for near convergence-excess esotropia and who were followed-up for at least 6 months after surgery. Patients who wore prisms were classified as PAT responders (esotropia <= 8 PD at distance and near with four-dot fusion at near) or nonresponders (exotropia at distance or lack of four 4-dot fusion at near). Responders underwent surgery for the adapted angle at near. The nonresponders who had exotropia at distance had surgery for an angle between the near and distance angles. Nonresponders with esotropia angles <= 8 PD at distance and near underwent surgery for the total near deviation. RESULTS: Fifty-four (83%) of the 65 children were PAT responders. Thirty-nine (72%) of the 54 responders and 6 (55%) of 11 nonresponders had excellent results (heterotropia <= 8 PD at distance and near with four-dot fusion at near). All 13 responders whose angles built with prism had excellent results. Among 61 patients who had an esotropia <= 8 PD at near with prisms preoperatively, only 4 (6.6%) developed overcorrections at distance by the latest follow-up examination; 3 were responders and 1 a nonresponder. CONCLUSIONS: PAT for the near deviation in children who have convergence-excess esotropia is a useful test in estimating the target angle for surgery. Responders whose angles built with prism had a particularly high success rate. Surgery geared to the near-adapted angle has a low risk of creating an overcorrection in the distance regardless of the response to PAT.     

Management of strabismus in nanophthalmic patients: a long-term follow-up report

PURPOSE: The purpose of this study is to identify the characteristics of strabismus that coexist with nanophthalmos and to report the results of strabismus surgery performed on these small eyes. DESIGN: Retrospective, consecutive, noncomparative interventional case series. PARTICIPANTS: Fifteen bilateral nanophthalmic patients, of whom five underwent horizontal muscle surgery, were included in this study. METHODS: Chart review. The clinical examination included visual acuity assessments using the linear Snellen and the Lea charts, slit-lamp and fundus examinations, intraocular pressure, and axial length measurements. The orthoptic examination consisted of measurements of ocular deviations using the prism cover test with an accommodative target at both near and distance with and without refractive correction, assessment of ocular motility with ductions and versions, binocularity with Worth's four-dot test, and the Titmus test. Amblyopia was treated with part-time occlusion. Surgery for the correction of esotropia included bilateral medial rectus recessions or recess-resect procedures. MAIN OUTCOME MEASURES: Magnitude of strabismic deviation, best-corrected visual acuity, and the level of binocular vision achieved were monitored. RESULTS: The average age of enrollment in the study was 4.7 (range, 1-12) years. The patients were followed for an average of 7.0 (range, 4-14) years. The mean axial length was determined as 18.4 mm (range, 15.5-20.7). The mean refractive error in spherical equivalents was measured as +9.9 and ranged between +4.0 and +15.0 diopters. Five patients (33%) had nonaccommodative esotropia, four (27%) had partially refractive esotropia, four (27%) had microesotropia, and two (13%) had exotropia. Five patients, all having nonaccommodative esotropia, underwent surgery for the correction of ocular misalignment. Diminishing the surgical dose in these small eyes resulted in undercorrections. Despite patching, 3 patients (20%) had unilateral and 12 patients (80%) had bilateral amblyopia at the conclusion of the study. CONCLUSIONS: Strabismus in nanophthalmos usually manifests as nonaccommodative and partially refractive esotropia. Medial rectus recession should be applied with care to prevent adduction deficit and convergence insufficiency. Otherwise, there seems to be no need for decreasing the surgical dose with regard to the smaller axial length. Amblyopia tends to be persistent in these patients.     

Split lengthening of the inferior oblique muscles

Split lengthening of the inferior oblique muscle(s) was performed in 20 patients for the correction of V-pattern, employing bilateral or unilateral surgery. In four patients unilateral split lengthening of the inferior oblique was done for the correction of hypertropia. The average correction of V-pattern was 16.9 pd with bilateral surgery and 13.3 pd with unilateral surgery. The average correction of hypertropia was 11.8 pd with only unilateral surgery.Dedicated to Dr. G.K. von Noorden on the occasion of his 60th birthday     

Surgical management of severe cocontraction, globe retraction, and pseudo-ptosis in Duane syndrome.

BACKGROUND: Correction of severe cocontraction and pseudo-ptosis present unique surgical challenges in patients with Duane syndrome. METHODS: We report four Duane syndrome patients with esotropia in primary position, poor abduction, and severe cocontraction causing limitation to adduction, globe retraction, and pseudo-ptosis. All were treated with partial tendon transposition of the vertical rectus muscles augmented with Foster fixation sutures and surgical weakening of the ipsilateral lateral rectus muscle. One patient had a large recession of the lateral rectus muscle, and in three patients, the lateral rectus muscle was inactivated by removing from the globe and attaching its insertion to the lateral orbital wall. RESULTS: Postoperatively, all patients were aligned within eight prisms diopters of orthotropia, had no face turn, and improved adduction and abduction. The two patients who had restriction to abduction on intraoperative forced ductions also had residual esotropia in primary position and underwent recession of the ipsilateral medial rectus muscle as a second procedure. Postoperative binocular single visual field was enlarged by 56 to 500% in the three patients who were tested preoperatively and postoperatively. Globe retraction and cocontraction were markedly relieved. Palpebral fissure widened 1.0 and 6.0 mm in two patients who had preoperative and postoperative measurements. CONCLUSION: In Duane syndrome patients, severe cocontraction, globe retraction, and limitation to adduction may improve if the lateral rectus muscle is maximally recessed or its insertion is inactivated from the globe. Partial transposition of the vertical rectus muscles augmented with Foster sutures improved the angle of esotropia in primary position and abduction. Medial rectus muscle recession is indicated when the passive forced duction test reveals moderate-to-severe restriction to abduction.     

209例A-V型斜视的临床表现和手术治疗

目的探讨A-V型斜视的病因、临床特点、手术矫正效果及手术方式。方法分析209例A-V综合征患者的临床表现、手术方式及治疗效果;所有患者依据是否伴有斜肌功能异常、原在位水平斜视及双眼单视功能情况行斜肌减弱术或/和水平肌手术,术后观察眼位、斜肌功能及双眼单视功能,随访3～24月,平均12月。结果A-V型斜视占同期斜视患者29.9%;其中,V型外斜占55.8%,A型外斜占9.1%,V型内斜占29.1%,A型内斜占6%;术后178例（85.1%）正位,192例（91.8%）A-V征消失,术后获得立体视功能者160例（76.5%）,包括术前16例具有立体视患者。结论A-V型斜视是一种常见的斜视类型,斜肌功能异常是发病的主要原因,原在位常合并水平斜视;根据是否伴有斜肌功能异常及双眼单视功能情况选择手术方式,多可获得较为满意的效果。     

Etiology and surgical management of horizontal pontine gaze palsy with ipsilateral esotropia.

INTRODUCTION: An esotropia ipsilateral to a horizontal pontine gaze palsy has been infrequently reported. We discuss the etiology and review the surgical management of this ocular motility defect. METHODS: Four patients with radiographically documented dorsal pontine lesions and persistent horizontal gaze palsy with esotropia ipsilateral to the gaze palsy were treated. In each patient, the esotropia was present in attempted primary gaze, producing symptomatic diplopia. An anomalous face turn was required to attain single binocular vision. RESULTS: All 4 patients underwent surgical correction to alleviate the anomalous head position and diplopia. Bilateral, asymmetric surgery was required to achieve a long-term successful result. Single binocular vision in the primary position with elimination or marked improvement of the compensatory head posture was initially achieved in all 4 patients. One patient, who had not undergone asymmetric strabismus surgery to reconcile incomitance produced by the esotropia, rapidly developed a residual esotropia. CONCLUSIONS: Ophthalmologists should recognize that concurrent esotropia may occur in patients with horizontal pontine gaze palsy. Single binocular vision in the primary position, an expanded binocular visual field, and alleviation of a compensatory head position are achievable with strabismus surgery.