J Korean Ophthalmol Soc.  2018 Mar;59(3):268-275. 10.3341/jkos.2018.59.3.268.

Periosteal Fixation Applied to Patients with Large-angle Paralytic Strabismus

• Eom HD
• Kwon YK
• Son BJ
• Chun BY

• KMID: 2406962
• DOI: http://doi.org/10.3341/jkos.2018.59.3.268

Abstract

PURPOSE
To evaluate the effect of periosteal fixation in patients with large-angle paralytic strabismus that was not corrected through conventional strabismus surgery.
METHODS
Four eyes of three patients with large-angle paralytic strabismus who underwent periosteal fixation from June 2014 to August 2014 were examined. All patients presented with exotropia > 50 prism diopters (PD). Two of them showed exotropia caused by chronic complete oculomotor nerve palsy; the other two showed exotropia caused by medial rectus muscle injury during endoscopic sinus surgery.
RESULTS
The mean preoperative exodeviation using the Krimsky test was 58 ± 29 PD. The postoperative values were 6.5 ± 9.4 PD at 1 week, and 11.25 ± 2.5 PD at 6 months. The mean surgical effect of exodeviation was 43.75 ± 21.36 PD.
CONCLUSIONS
Periosteal fixation is an effective surgery for the management of paralytic strabismus that was not corrected through conventional strabismus surgery.

Keyword

Exotropia; Paralytic strabismus; Periosteal fixation

MeSH Terms

Exotropia
Humans
Oculomotor Nerve Diseases
Strabismus*

Figure

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  Figure 1. Schematic drawings of periosteal fixation technique. (A) Incision is made at the precaruncular conjunctiva. (B) Blunt dissection is continued medially between caruncle and posterior lacrimal crest. (C) Nonabsorbable double armed 5-0 nylon sutures are passed through the periosteum. (D) Medial rectus insertion is exposed using limbal conjunctival approach. (E) Sutures are held with the needle tips and brought out in the sub-Tenon's space using mosquito forceps. (F) Sutures are passed on the sclera in either side of the medial rectus muscle.

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  Figure 2. Case 2. Preoperative orbital magnetic resonance imaging showing transected both medial rectus muscles (arrows).

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  Figure 3. Case 2. Nine gaze photograph of a 62-year-old male patient with transected both medial rectus muscle after endoscopic sinus surgery. Before surgery, showing exotropia of above 100 prism diopters and limitation of adduction of the both eyes.

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  Figure 4. Case 2. One month after periosteal fixation surgery of the left eye, showing exotropia of 40 prism diopters in primary position.

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  Figure 5. Case 2. Six months after periosteal fixation of the right eye, showing exotropia of 15 prism diopters in primary position.

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