Medial Rectus Research Articles

Relationships between tilt angles of rectus muscles and positions of rectus muscle pulleys in patients with sagging eye syndrome.

To examine the relationship between the rectus muscle (RM) angle and RM pulley displacement in patients with sagging eye syndrome (SES) without myopia. Retrospective cross-sectional case series. High-resolution quasi-coronal magnetic resonance imaging (MRI) data from 20 orbits of ten Japanese patients with SES but without high myopia were analyzed. The patients had no abduction deficiency. The RM angles were measured between the major axes of the horizontal and vertical RMs relative to the vertical and horizontal planes, respectively. The positions of the RM pulleys relative to the center of the globe were analyzed as previously described. The mean age of the patients was 75.8 ± 4.5 years (standard deviation). The average axial length was 23.6 ± 0.6 mm. The lateral rectus (LR) muscle angle (22 ± 6°) had moderate negative correlations with the inferior displacement of the inferior rectus (IR), superior rectus (SR), and LR pulleys (r =-0.63,-0.45, and-0.45, respectively); however, no change was observed in the medial rectus (MR) pulley (r =-0.41). No correlations were found between the angles of the SR (4 ± 8°), IR (-13 ± 8°), and MR (-1 ± 6°) muscles and the positions of the RM pulleys. Given the correlation between increased LR muscle angle and inferior displacement of adjacent RM pulleys in SES, the LR muscle angle may serve as a diagnostic clue, even when inferior displacement is not identifiable on MRI. Further confirmation in larger studies is warranted.

Long-term surgical outcomes of esotropic duane retraction syndrome type 1

Duane retraction syndrome (DRS) is complicated to treat due to its wide spectrum of clinical presentations and the treatment of choice varies among surgeons. To provide insight into this challenging condition, we evaluated the long-term surgical outcomes of esotropic DRS type 1. The surgical motor success, defined as a horizontal deviation of 8 prism diopters (PD) or less, was found in 77.3% of patients after an average follow-up of 5.6 ± 3.4 years. After surgery, a gradual shift towards exotropia was observed at an average rate of 1.3 ± 3.7 PD exodrift per year. In this study, the long-term surgical outcomes were generally favorable in esotropic DRS type 1. However, due to the nature of exodrift over time following medial rectus recession, it is crucial to educate the patient about the potential long-term overcorrection, and to carefully calculate the appropriate surgical dosage.

Horizontal extraocular muscle insertion locations in children undergoing extraocular muscle surgery.

The location of extraocular muscle (EOM) insertions is clinically relevant in ophthalmologic surgery. The spiral of Tillaux has been a reference for normal EOM insertion since the nineteenth century. Research on EOM insertions is limited and has focused on adult cadaveric eyes. In this study we investigated the location of EOM insertions in children undergoing EOM surgery. Children who underwent EOM surgery for strabismus or anomalous head position at a large tertiary care center were consecutively identified from October 2022 to December 2023. Intraoperative measurements of medial rectus (MR) and lateral rectus (LR) insertions were compared to the spiral of Tillaux and within patient groups using one-sample and independent-samples t tests, respectively. Associations of EOM insertions with age, refraction, and axial length were evaluated with Pearson correlation. In 292 children who underwent EOM surgery, 528 previously unoperated EOM insertions were recorded. Mean insertions were closer to the limbus than expected by the spiral of Tillaux (MR, 5.21 vs 5.5 mm [P < 0.001]; LR, 6.76 vs 6.9 mm [P = 0.001]). Esotropia was associated with closer EOM insertions than exotropia (MR, P = 0.021; LR, P = 0.045). Males had farther MR insertions than females (5.33 vs 5.03 mm [P < 0.001]). Age was weakly associated with farther EOM insertions (MR, r = 0.215, P < 0.001; LR, r = 0.232, P < 0.001). Myopia was very weakly associated with farther MR insertions (r = -0.145, P = 0.024). In children undergoing EOM surgery, MR and LR insertions were closer to the limbus than expected relative to the spiral of Tillaux. This finding may have implications for surgical planning and outcomes.

Evaluation of Inflammatory Activity of Extraocular Muscles in Thyroid Associated Orbitopathy by [68Ga]DOTATATE PET/CT.

The accurate assessment of inflammatory activity of the extraocular muscles (EOMs) in thyroid associated ophthalmopathy (TAO) is crucial for formulating subsequent treatment strategies and prognostic judgments. This study aims to explore the efficacy of using [68Ga]DOTATATE PET/CT to assess the inflammatory activity of EOMs in TAO patients. This study enrolled 22 TAO patients and 6 healthy volunteers, all of whom underwent orbital [68Ga]DOTATATE PET/CT. Among these, 18 patients underwent orbital [99mTc]DTPA SPECT/CT within one week, and the other 4 patients received orbital MRI. All imaging data were independently assessed, followed by comparative data analysis. The patients then received different treatment schemes, and their prognosis was followed up. [68Ga]DOTATATE PET/CT could effectively evaluate the inflammatory activity of the EOMs in TAO patients and demonstrate good consistency with [99mTc]DTPA SPECT/CT and orbital MRI, but show a better resolution to distinguish EOMs and surrounding structure. The receiver operating characteristic (ROC) curves for each EOM, treated as individual research units, exhibited an area under the curve (AUC) exceeding 0.9. The medial rectus demonstrated the highest involvement and diagnostic accuracy(AUC = 0.976, P < 0.001). Patients treated with glucocorticoids showed significantly higher SUVmax in EOMs compared to those receiving symptomatic treatment (P < 0.01). [68Ga]DOTATATE PET/CT is a reliable method for assessing the inflammatory activity of EOMs in TAO patients, providing strong objective evidence for the precise diagnosis and treatment.

TOM500: A Multi-Organ Annotated Orbital MRI Dataset for Thyroid Eye Disease

This study presents TOM500, a comprehensive multi-organ annotated orbital magnetic resonance imaging (MRI) dataset. It includes clinical data, T2-weighted MRI scans, and corresponding segmentations from 500 patients with thyroid eye disease (TED) during their initial visit. TED is a common autoimmune disorder with distinct orbital MRI features. Segmentations of nine orbital structures, including the optic nerve, orbital fat, lacrimal gland, eyeball, and five extraocular muscles (superior rectus and levator palpebrae superioris complex, inferior rectus, medial rectus, lateral rectus, and superior oblique), were generated by three junior annotators and reviewed by an expert radiologist. The consistency of the segmentations was evaluated using the intraclass correlation coefficient. Clinical data, including sex, age, disease duration, and smoking status, are also provided for disease diagnosis and classification. TOM500, the largest publicly available orbital MRI dataset with expert annotations, is designed to facilitate the development of advanced computational tools for TED diagnosis, classification, and observation.

Bilateral lateral rectus recession versus bilateral lateral rectus recession and one medial rectus resection in correction of exotropia

Purpose The aim of this study was to compare the results of bilateral lateral rectus (BLR) recession to combined BLR recession and one medial rectus (MR) resection in concomitant exotropia (XT) of 40–55 prism diopters (PD). Patients and methods This is a prospective randomized clinical trial that was conducted on 69 XT patients, divided into two groups; group A: BLR recession (n=39 patients) and group B: BLR recession+MR resection (n=30 patients). All study patients were subjected to routine preoperative evaluation, operative procedure in standardized numbers and technique and postoperative follow up to 6 months for alignment in the primary position, ocular motility, and palpebral fissure height (PFH) measurement. Results At the 6-month follow up visit, the success rate (patients with postoperative results ≤8 PD of orthophoria) was 66.7% in group A compared to 73.3% in group B, with no statistically significant difference (P=0.551). The postoperative PFH was significantly different from the preoperative PFH at all follow-up visits in both groups. In group A, the preoperative PFH was 10.59±1.23 mm and increased to 11.40±1.26 mm at 6 months (P&lt;0.001), while in group B, the preoperative PFH was 10.45±1.36 mm and decreased to 10.03±1.33 mm at 6 months postoperatively (P&lt;0.001), with a noted higher mean of postoperative PFH in group A by 7.6% and a lower mean of postoperative PFH in group B by 4%. In group B, the eye with single LR recession showed a 2.15±5.26% increase in PFH while the eye with combined recession and resection showed a 9.39±2.99% decrease in PFH. Lateral gaze deficit was related to XT more than or equal to 50 PD as a significant difference was found on comparing the patients with and without lateral gaze deficit for angle of 50 PD (P=0.028) and for angle of 55 PD (P=0.050). Conclusion The three-muscle procedure was as effective as the two-muscle procedure in correction of comitant XT regarding the postoperative alignment. Adding MR resection led to PFH narrowing. Lateral gaze deficit can occur with large lateral rectus recession for XT of 50 PD and more.

Effects of strabismus surgery on cornea

Background Strabismus is a common disorder that is mostly treated surgically. Extraocular muscle surgery may induce refractive and corneal topographic changes. Aim To study the effect of horizontal strabismus surgery on corneal topography Patients and methods This prospective interventional randomized study was carried out on 20 patients aged from 5 to 30 years old diagnosed with horizontal strabismus who did not undergo any ocular surgery before. They were divided into four groups. We did lateral rectus recession in the first group, lateral rectus resection in the second group, medial rectus resection in the third group, and medial rectus recession in the fourth one. We compared the spherical equivalent and the corneal topographic parameters (K1, K2, the power and the axis of the astigmatism) preoperative, at 1 month postoperative, and at 6 month postoperative. Results There was myopic shift in the spherical equivalent in all groups and it was more significant after recession surgery. There was a statistically significant change in K1, K2, and astigmatism power after recession of medial and lateral recti muscles which persisted till the postoperative sixth month. The change after resection of medial and lateral recti muscles was insignificant. The change in the axis was insignificant in all groups. Conclusions Recession surgery of medial or lateral recti has more effect on refraction and corneal topography than resection. Horizontal strabismus surgeries induce a significant myopic shift in the spherical equivalent and do not induce a significant change in the axis.

Horizontal rectus muscle insertion sites in patients with infantile esotropia and acute acquired concomitant esotropia.

To investigate the characteristics of horizontal rectus muscle insertion sites in patients with infantile esotropia (IE) and acute acquired concomitant esotropia (AACE). The medical records of 166 IE patients and 261 AACE patients who underwent horizontal rectus muscle surgeries were reviewed retrospectively, including age at surgery, spherical equivalent (SE), and angle of esodeviation at near and distance. The limbus-insertion distances (LID) and widths of the medial rectus (MR) and lateral rectus (LR) muscles were measured intraoperatively using a caliper. The insertion parameters and clinical features were compared between different ages and types of esotropia, and a correlation analysis was performed between these variables. In IE patients under 12 years old, the MR LID was positively correlated with age, whereas the LR LID was negatively correlated with the angle of esodeviation at distance. In IE patients over 12 years old, the LR width was negatively correlated with the angle of esodeviation at near. In AACE patients, the MR LID was negatively correlated with the angle of esodeviation at distance, whereas the LR width was negatively correlated with the SE. The LID and width of the horizontal rectus muscle insertions were not significantly different in age-matched patients with IE and AACE. In IE patients, the LR insertion parameters were correlated with the angle of esodeviation, but in AACE patients, the MR LID was correlated with the angle of esodeviation. The clinical significance of these findings still needs to be investigated further.

Tuberculoma causing isolated pseudoabducens palsy

Tuberculomas are the most common cerebrovascular complications in extrapulmonary tuberculosis. Pseudoabducens palsy is a neurological limitation of abduction when the abducens nerve is intact. We describe a case of isolated left pseudoabducens palsy in a young male patient with tubercular meningitis and thalamic tuberculoma revealed by magnetic resonance imaging. The patient presented with horizontal binocular diplopia and reduced levoversion which was abolished on demonstrating vestibulo-ocular reflex. This case supports the hypothesis that damage to direct inhibitory projections from the thalamus or impairments of inputs to midbrain neurons involved in vergence control may lead to tonic activation of medial rectus muscle causing thalamic esotropia.

Ultrasound B-Scan for Posterior Segment and Extraocular Evaluation in Ocular Cysticercosis.

Cysticercosis, caused by Taenia solium larvae, can affect various ocular and extraocular structures, leading to significant morbidity. Ultrasound B-scan imaging plays a pivotal role in diagnosing and classifying cysticercosis lesions.The aim of the study was to describe the ultrasound B-scan characteristics of ocular and extraocular cysticercosis, proposing a classification system based on anatomical localization to enhance understanding and management. A retrospective study of consecutive cases with intraocular or extraocular cysticercosis was conducted from January 1993 to December 2023 in Mumbai, India. B-scan ultrasound was performed by an experienced imaging specialist. Descriptive statistics were used to summarize demographic characteristics and the proportion of cysticercosis in each anatomical location. Cysticercosis lesions were classified based on anatomical location observed during imaging. Amongst the 56 eyes evaluated, intraocular posterior segment involvement (n=25) and extraocular involvement (n=31) were observed. Extraocular cysticercosis predominantly affected the medial rectus muscle (40%), followed by the inferior rectus (28%), lateral rectus (20%), and superior rectus muscles (12%). Orbital cysts were localized in the posterior extraconal (50%), anterior extraconal (34.33%), and intraconal (16.67%) regions. Intra-vitreous cysticercosis (n=9) exhibited thin-walled cysts with minimal inflammation, progressing to thickened cyst walls in the late stages. Sub-hyaloid cysticercosis (n=8) showed initial thin vitreous detachment, progressing to thickened vitreous adhesions. Sub-retinal cysticercosis (n=9) without retinal detachment indicated early disease, while cases with detachment suggested disease progression. The proposed anatomical classification system based on B-scan ultrasound features provides a structured approach to categorizing cysticercosis lesions, enhancing understanding and management in ophthalmic practice.

Modified Nishida procedure for the treatment of complete cranial nerve palsies: A case series

Aims/Purpose: To describe the clinical characteristics and outcomes of a series of strabismus patients with horizontal recti palsies treated surgically with a Modified Nishida Procedure (MNP).Methods: A retrospective review of patients who underwent a MNP at Hospital de Santa Maria in Lisbon, Portugal, between November 2023 and February 2024 (n = 5). MNP is a no‐tenotomy, no‐splitting transposition of 1/3 of the muscle body of the vertical recti to the midpoint between itself and the affected horizontal rectus muscle. Inclusion criteria included diplopia due to Grade IV or V palsies of the lateral rectus (LR, n = 4) due to VI nerve palsy or of the medial rectus (MR, n = 1) due to III nerve palsy. A 3‐month post‐operative follow‐up was required. Surgical success was defined as post‐operative horizontal deviation ≤14 prism diopters (PD) and absence of horizontal diplopia in primary gaze.Results: Mean age was 60±13 years. Two patients had bilateral LR palsy with &gt; 85PD esotropia (ET) and received bilateral MNP combined with 6mm MR recession, with additional MR botulinum toxin (BT) injection two weeks later. Two patients had unilateral LR palsy with 45 PD ET with previous 7mm MR recession: these received unilateral MNP. Surgical success was achieved in 3 of these 4 cases. The unsuccessful case had 40PD residual ET and diplopia at 4 months follow‐up. There were two cases of self‐limiting post‐operative ptosis and one case of a surgical complication where the whole vertical rectus body was transposed due to high muscle friability. The MR paralysis patient had 40PD exotropia and MNP was combined with 7mm LR recession. Surgical success was achieved in this case, and no intra‐ or post‐operative complications occurred. No cases of anterior segment ischemia were detected in this series.Conclusions: MNP is an effective surgical option as it greatly reduces the horizontal deviations and diplopia associated with severe cranial nerve palsies and has a reduced risk of complications.

Modified nishida procedure for the treatment of complete cranial nerve palsies: A case series

Aims/Purpose: To describe the clinical characteristics and outcomes of a series of strabismus patients with horizontal recti palsies treated surgically with a Modified Nishida Procedure (MNP).Methods: A retrospective review of patients who underwent a MNP at Hospital de Santa Maria in Lisbon, Portugal, between November 2023 and February 2024 (n = 5). MNP is a no‐tenotomy, no‐splitting transposition of 1/3 of the muscle body of the vertical recti to the midpoint between itself and the affected horizontal rectus muscle. Inclusion criteria included diplopia due to Grade IV or V palsies of the lateral rectus (LR, n = 4) due to VI nerve palsy or of the medial rectus (MR, n = 1) due to III nerve palsy. A 3‐month post‐operative follow‐up was required. Surgical success was defined as post‐operative horizontal deviation ≤14 prism diopters (PD) and absence of horizontal diplopia in primary gaze.Results: Mean age was 60±13 years. Two patients had bilateral LR palsy with &gt; 85PD esotropia (ET) and received bilateral MNP combined with 6mm MR recession, with additional MR botulinum toxin (BT) injection two weeks later. Two patients had unilateral LR palsy with 45 PD ET with previous 7mm MR recession: these received unilateral MNP. Surgical success was achieved in 3 of these 4 cases. The unsuccessful case had 40PD residual ET and diplopia at 4 months follow‐up. There were two cases of self‐limiting post‐operative ptosis and one case of a surgical complication where the whole vertical rectus body was transposed due to high muscle friability. The MR paralysis patient had 40PD exotropia and MNP was combined with 7mm LR recession. Surgical success was achieved in this case, and no intra‐ or post‐operative complications occurred. No cases of anterior segment ischemia were detected in this series.Conclusions: MNP is an effective surgical option as it greatly reduces the horizontal deviations and diplopia associated with severe cranial nerve palsies and has a reduced risk of complications.

Pterygium extended removal followed by minor ipsilateral simple limbal epithelial transplantation (PERMISLET): An innovative technique for recurrent pterygium.

We describe a novel technique for recurrent pterygium and assess the advantage of properties of extended tenonectomy, amniotic membrane transplantation, and limbal epithelial transplantation in terms of recurrence rate, postoperative symptoms, postoperative orthoptics, and other complications. A total of nine eyes with recurrent pterygium underwent PERMISLET, i.e., pterygium extended removal (PER) (removal of tenon capsule with fibrovascular tissue around medial rectus from limbus till medial canthus) followed by minor ipsilateral limbal epithelial transplantation (coverage of bare sclera with amniotic membrane graft and placement of ipsilateral limbal pieces at the affected limbus). The patients were reviewed on day 1, day 7, and day 30 and at third, sixth, and twelfth month after surgery, and none of the eyes (0/9) showed recurrence of pterygium on to the cornea. Time taken for surgery was 53.88 ± 8.74 minutes (range, 45 to 75 minutes). Postoperative discomfort (pain, irritation, foreign body sensation, and lacrimation) persisted mainly for day 1 after the surgery. However, lacrimation persisted till day 7 in two of the patients. Intraoperative complications were seen in none of the eyes. A total of 1/9 patients had granuloma formation, and 1/9 had dellen formation in postoperative period with successful management. Moreover, none of the eyes (0/9) developed ocular motility restrictions in postoperative period. PERMISLET, an innovative surgical technique for recurrent pterygium, is a viable option with zero rate of recurrence and minimal complications, a boon for patients with limited healthy conjunctiva or a potential for future glaucoma drainage procedures.

Isolated unilateral medial rectus palsy: a rare presentation of midbrain infarction in a child

This case study describes a rare instance of isolated unilateral medial rectus palsy in a young patient with Fabry disease, an X-linked lysosomal storage disease. A five-and-a-half-year-old child did not exhibit any other symptoms associated with a stroke, other than abrupt onset diplopia and a pronounced left-eye squint. Isolated medial rectus palsy as a sole presentation of midbrain infarct is a rare entity. Fabry disease is associated with an increased risk of ischemic strokes in patients because of the build-up of glycosphingolipids in the vascular endothelium. This case emphasizes how crucial it is to conduct early neuroimaging and to have a high index of suspicion when dealing with uncommon neurological presentations, particularly in individuals who have underlying genetic conditions like Fabry disease.

Patterns of Extraocular Muscle Enlargement in Graves' Orbitopathy and Acromegaly.

Purpose: Extraocular muscle (EOM) enlargement occurs in both acromegaly and Graves' disease, but the degree and pattern of enlargement have not been directly compared in these patient groups. This study investigated whether acromegaly and Graves' orbitopathy (GO) are associated with different patterns of EOM enlargement at the time of diagnosis. Study Design: Retrospective cohort. Methods: All new patients with a diagnosis of acromegaly or GO who presented to St Joseph's Health Care in London, Ontario, between January 1, 2015, and July 1, 2020, and who underwent computed tomography (CT) scanning with adequate orbital imaging were considered for inclusion. We included age- and sex-matched control patients with pituitary macroadenomas without thyroid or growth hormone abnormalities. Orbital CT scans were analyzed by a single neuroradiologist, who measured the maximum diameter and cross-sectional area of each EOM. The relative likelihood of involvement of each rectus EOM was analyzed separately using an analysis of variance test. Results: We included 16 patients with GO, 17 with acromegaly, and 18 controls. Ages (mean ± standard deviation) of groups were 55.6 ± 18.0, 50.2 ± 15.7, and 49.3 ± 14.0 years. The mean maximum diameter of EOMs in GO, acromegaly, and controls was inferior rectus (IR) = 4.77 ± 1.53, 4.66 ± 0.61, and 3.68 ± 0.61 mm; medial rectus (MR) = 5.35 ± 2.23, 4.84 ± 0.81, and 3.65 ± 0.42 mm; superior rectus (SR) = 4.94 ± 1.84, 4.88 ± 0.91, and 3.68 ± 0.61 mm; and lateral rectus (LR) = 3.91 ± 1.59, 4.55 ± 0.60, and 3.20 ± 0.43 mm. The IR, MR, and SR muscles were significantly larger in the GO group compared with controls (IR, p = 0.020; SR, p = 0.004; MR, p < 0.001; and LR, p = 0.166), and all four EOMs were larger in acromegaly compared with controls (IR, p = 0.039; SR, p = 0.006; MR, p = 0.006; and LR, p = 0.001). There was no significant difference between the GO and acromegaly groups (IR, p = 0.959; SR, p = 0.987; MR, p = 0.408; and LR, p = 0.250). Conclusions: GO and acromegaly groups demonstrated the enlargement of the IR, MR, and SR muscles when compared with controls. The GO group did not show significantly larger EOM sizes compared with the acromegaly group. In the GO group, the IR, MR, and SR were similarly affected and did not follow previously described patterns of enlargement in GO.

Orbital Septum Posterior to Medial Canthal Tendon Area.

To examine the anatomy of the orbital septum posterior to the medial canthal tendon area. We performed 3 anatomical dissections in the present study. The first one was a microscopic study in which exenterated specimens from 6 Japanese cadavers (age from 77 to 93 years at death) were cut inferno-horizontally, including the Müller muscle, medial rectus pulley, and lateral rectus pulley, and stained with Masson's trichrome. The second one was also a microscopic study in which the exenterated specimens from 5 Japanese cadavers (age from 73 to 87 years at death) were cut horizontally, 1 mm superior to the upper eyelid margin and 1 mm inferior to the lower eyelid margin, and stained with Masson's trichrome. The third one was a macroscopic study in which exenterated specimens from 5 Japanese cadavers (age from 73 to 91 years at death) were cut horizontally at the medial palpebral commissure. In the first study, all the specimens showed the orbital septa with close vicinity to the orbicularis oculi muscle in the medial area. The second and third studies both demonstrated the double lamellar structure of the medial canthal tendon area. The anterior one was the fibrous tissue corresponding to the white medial canthal tendon. The posterior one referred to the preseptal orbicularis oculi muscle. The orbital septum was located directly posterior to this muscular structure. The orbital septum posteriorly lined the preseptal orbicularis oculi muscle, the muscular part of the medial canthal tendon.

To remove or not to remove: Intraconal metallic foreign body following perforating ocular injury

Background: Foreign bodies (FB) are implicated in 17-30% of penetrating ocular injuries. We encountered 2 cases of perforating ocular trauma with metallic intra-orbital FB in 2 teenage males. Case report: A 17-year-old male presented with a nail-hammer injury 6 hours after trauma. Snellen’s acuity was 3/60 with a corneal laceration of 5mm with lens matter in the anterior chamber and vitreous hemorrhage. After primary repair by the anterior segment surgeon, posterior segment surgery was done following the diagnosis of retinal detachment (RD) and intra-ocular Foreign Body(FB) by ultrasound. No FB was noted intraoperatively. On Computerized Tomography (CT), metallic FB 5.2x3.5 mm was noted at the insertion of the inferior oblique muscle. Removal of IOFB was deferred by the oculoplasty department. Delayed oil removal was done with final Snellen’s acuity 6/12p. Another 16-year-old male attended the retina clinic 20 days after injury with a metal-on-metal hammering incident. Primary topical management was done elsewhere. Snellen’s acuity was 6/18p in the affected eye. The site of FB entry was scleral,1.4 mm from limbus at 9 o’clock with no associated lens trauma. CT scan of the brain and orbit showed intra-orbital FB medial to the medial rectus near the orbital apex. FB (4.4x4.3 mm) left a tract in subretinal space to enter intraconal space 1 disc diameter nasal to optic disc. Vitrectomy was done for tractional RD and postoperative Snellen’s vision was 6/12. Conclusion: A high degree of clinical suspicion is necessary to detect and localize IOFB. Non-toxic intra-orbital FB may be left in the context of good vision in the affected eye and possible iatrogenic optic nerve damage.

Y-split Recession of Lateral Rectus With and Without Medial Rectus Recession in the Management of Exotropic Duane Retraction Syndrome With Significant Overshoot and Retraction.

To compare the effectiveness of two surgical approaches in the management of exotropic Duane retraction syndrome (DRS) cases with significant overshoot and retraction. A retrospective analysis was conducted on patients with exotropic DRS who experienced significant overshoot and globe retraction. Patients with incomplete medical records or previous strabismus surgery were excluded. Overshoot and retraction were graded on a scale of 1 to 3. Surgical outcomes were assessed based on exotropia correction, head turn correction, leash correction, and globe retraction correction. Twenty-one patients with unilateral type III exotropic DRS were included in the study. The Y-split recession of the lateral rectus muscle (LR) group comprised 13 patients who underwent Y-split recession of the LR alone and the Y-split recession of LR + ipsilateral MR recession group consisted of 8 patients who underwent Y-split LR recession combined with medial rectus (MR) recession. The average of exotropia and head turn correction was higher in the Y-split recession of LR group (15.76 prism diopters [PD], 18.46°) compared with the Y-split recession of LR + ipsilateral MR recession group (11.12 PD, 12.12°). On the other hand, the Y-split recession of the LR + ipsilateral MR recession group exhibited higher mean correction grades for leash and retraction (2.63 and 2.5, respectively) compared to the Y-split recession of LR group (2.31 and 1.92, respectively). Both surgical approaches showed promising results in managing exotropic DRS cases with significant overshoot and retraction. Y-split LR recession combined with MR recession could possibly be a better surgical option in cases where severe retraction and overshoot are the main issues. Further investigations with larger sample sizes are necessary to validate these findings and determine the optimal surgical approach. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XXX-XXX.].

Successful outcome in synergistic divergence after unilateral lateral rectus recession and medial rectus resection

Successful outcome in synergistic divergence after unilateral lateral rectus recession and medial rectus resection

Analysis of Added Postoperative Diplopia After Transnasal Endoscopic Inferomedial Wall Decompression for Thyroid-Associated Ophthalmopathy.

The authors retrospectively analyzed the reported rate of added diplopia and associated factors in patients with thyroid-associated ophthalmopathy (TAO) after transnasal endoscopic inferomedial wall decompression, to illuminate the issue and look for ways to improve prognosis. Retrospective analysis was done on the medical records of patients with moderate-to-severe TAO between 2023-01 and 2024-01. Under general anesthesia, transnasal endoscopic inferomedial wall decompression was carried out on each subject. Clinical outcomes included postoperative added diplopia (including new-onset and aggravated), strabismus, and alterations in the extraocular muscles. Sixty-five eyes in 65 patients received treatment. Nineteen patients (29.3%) had new-onset horizontal diplopia at 1 month and 10 patients (15.4%) at 6 months postoperatively; 9 patients (13.8%) experienced aggravated horizontal diplopia at 1 month and 6 patients (9.2%) at 6 months (C2=4.947, P<0.05). The average volume of the medial rectus muscle was the only one to increase in the extraocular muscles (F=34.131, P<0.001), and the preoperative medial rectus muscle volume was higher in the added diplopia patients than in the no-added diplopia patients (F=267.405, P<0.001). Postoperative diplopia (both new-onset and aggravated) increased in TAO with transnasal endoscopic inferomedial wall decompression. Most added diplopia was horizontal and most added strabismus was esotropia. They were closely associated with changes in the medial rectus's thickness, displacement, and structural alterations. The preoperative medial rectus volume is one of the possible markers of further postoperative diplopia.