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Jonathan M Holmes - One of the best experts on this subject based on the ideXlab platform.
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diabetes and hypertension in isolated Sixth Nerve Palsy a population based study
Ophthalmology, 2005Co-Authors: Sanjay V Patel, Jonathan M Holmes, David O Hodge, James P BurkeAbstract:Purpose Diabetes mellitus and systemic hypertension are frequently reported as ischemic causes of Sixth Nerve Palsy/paresis, but there are few rigorous studies to support these associations. We conducted a population-based case-control study to determine the presence and magnitude of any association of preexisting diabetes mellitus and systemic hypertension with isolated Sixth Nerve Palsy. Design Retrospective population-based case-control study. Participants and Controls Participants were patients with new onset of neurologically isolated Sixth Nerve Palsy or paresis (n = 76) in Olmsted County, Minnesota, from January 1, 1978, to December 31, 1992. Controls (n = 76) were selected from the same general population and were matched for age, gender, and length of medical follow-up. Methods Using the Rochester Epidemiology Project medical records linkage system, which captures virtually all medical care provided to residents of Olmsted County, Minnesota, we identified all incident cases of neurologically isolated Sixth Nerve Palsy/paresis (n = 76) among county residents between the given dates. An equal number (n = 76) of controls were randomly selected from the general population. We reviewed the entire medical record of each case and control, using stringent predetermined criteria to define the presence of diabetes mellitus and systemic hypertension. We compared the prevalence of diabetes and systemic hypertension between cases and controls by use of chi-square tests, and we calculated odds ratios (OR) with 95% confidence intervals (CI). Main Outcome Measures Presence or absence of diabetes mellitus and systemic hypertension. Results Diabetes mellitus occurred more frequently in cases (23.7%) than in controls (5.3%; P = 0.001; OR, 5.59; 95% CI, 1.79–17.42). Systemic hypertension occurred with similar frequency in cases (51.3%) and controls (39.5%; P = 0.14; OR, 1.62; 95% CI, 0.85–3.08). Coexistent diabetes mellitus and hypertension were more common in cases (18.4%) than in controls (2.6%; P = 0.002; OR, 8.36; 95% CI, 1.83–38.18). Conclusions We conclude that there is a 6-fold increase in odds of having diabetes in cases of Sixth Nerve Palsy over controls, whereas systemic hypertension does not seem to be associated with increased odds. In contrast, there is an 8-fold increased odds of having coexistent diabetes and hypertension in cases of Sixth Nerve Palsy over controls. The much-cited association of systemic hypertension alone with Sixth Nerve Palsy may be coincidental.
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incidence associations and evaluation of Sixth Nerve Palsy using a population based method
Ophthalmology, 2004Co-Authors: Sanjay V Patel, Srinivas Mutyala, David O Hodge, David A Leske, Jonathan M HolmesAbstract:Abstract Purpose To determine the incidence of Sixth Nerve Palsy in a population-based study, with particular emphasis on associated coexisting medical conditions and to use these data to develop a management algorithm. Design Retrospective, population-based case series. Participants All residents of Olmsted County, Minnesota, USA, diagnosed with Sixth Nerve Palsy between January 1, 1978 and December 31, 1992. Methods All cases were identified by using the Rochester Epidemiology Project medical records linkage system, which captures all patient-physician encounters in Olmsted County. The entire medical record of each patient was reviewed to confirm the diagnosis, document county residency, and to determine associated medical conditions. We used stringent predetermined criteria to define diabetes mellitus and hypertension as associations. Incidence rates were adjusted to the age and gender distribution of the 1990 white population in the United States. Main outcome measures Etiology or systemic associations of the Palsy. Results We identified 137 new cases of Sixth Nerve Palsy over the 15-year period. The age- and gender-adjusted annual incidence of Sixth Nerve Palsy was 11.3/100 000 (95% confidence interval, 9.3–13.2/100 000). Causes and associations were: undetermined (26%), hypertension alone (19%), coexistent hypertension and diabetes (12%), trauma (12%), multiple sclerosis (7%), neoplasm (5%), diabetes alone (4%), cerebrovascular accident (4%), postneurosurgery (3%), aneurysm (2%), and other (8%). When Sixth Nerve Palsy was the presenting sign in cases of neoplasm (n = 1) and aneurysm (n = 3), history and examination revealed the presence of other neurologic symptoms or signs. Conclusions We provide population-based data on the incidence of Sixth Nerve Palsy with a notably lower incidence of neoplasm and higher incidence of diabetes and hypertension than previous institution-based series. We suggest that patients with nontraumatic neurologically isolated Sixth Nerve Palsy may undergo a focused medical evaluation followed by close observation, whereas non–neurologically isolated cases warrant a full neurologic evaluation, including prompt neuroimaging.
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long term outcomes after surgical management of chronic Sixth Nerve Palsy
Journal of Aapos, 2002Co-Authors: Jonathan M Holmes, David A LeskeAbstract:Background: In a multicenter prospective data collection study of chronic Sixth cranial Nerve Palsy, we previously reported that the initial successful outcome rate was 39% after a single surgical intervention and 25% after surgery combined with botulinum toxin (Botox), using strict success criteria. We now report the longer term outcome of these patients. Methods: A previously described cohort of 31 patients in 18 centers who underwent strabismus surgery for a Sixth Nerve Palsy of greater that 6 months duration was studied prospectively. Twenty-three had strabismus surgery alone and 8 surgery with Botox. Fourteen (45%) were complete palsies and 17 (55%) were incomplete. Seven (23%) were bilateral and 24 (77%) were unilateral. Outcome was classified at time of last follow-up, which was 5 weeks to 24 months postoperatively. Success was defined as no diplopia in primary position at distance fixation. Partial success was defined as no more than 10 PD esotropia despite diplopia. Results: Overall, 16 (52%) of the patients were classified as successes, 7 (23%) as partial successes, and 8 (25%) as failures. Three (43%) of the partial successes were using prism. Eight (35%) of the patients classified as successes or partial successes required 2 surgical procedures. Of all patients (10, 32%) who had a second surgery, only 2 (20%) remained failures. Conclusions: Despite our reported poor initial surgical success rate in chronic Sixth Nerve Palsy, additional strabismus surgery, longer follow-up, and the use of prism or face turn for small residual deviations yields an overall surgical success rate of 75%. More than 1 surgical procedure and prism are often necessary in the management of chronic Sixth Nerve Palsy. (J AAPOS 2002;6:283-8)
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initial treatment outcomes in chronic Sixth Nerve Palsy
Journal of Aapos, 2001Co-Authors: Jonathan M Holmes, David A Leske, Stephen P ChristiansenAbstract:Introduction: We conducted a prospective multi-center, nonrandomized, data-collection study of patients with chronic Sixth cranial Nerve Palsy. We evaluated success rates with conservative nonsurgical management, botulinum toxin (botox) treatment, strabismus surgery, and a combination of botox treatment and surgery. Methods: All members of the American Association for Pediatric Ophthalmology and Strabismus and the North American NeuroOphthalmology Society were invited to enroll patients with Sixth Nerve Palsy or paresis of more than 6 months duration over a 2-year period (between March 1998 and February 2000). The botox and surgical groups received intervention within 3 months of enrollment. Success at 6 months from enrollment was defined as absence of diplopia in primary position and no more than 10 prism diopters (pd) distance esotropia in primary position. Patients with no follow-up were excluded. Results: Fifty-six eligible patients were enrolled by 33 investigators. Eighteen (32%) were traumatic in etiology, 15 (27%) were unknown (including presumed hypertensive), 14 (25%) were neoplastic, 2 (4%) were diabetic, and 7 (13%) were other. Twenty (35%) were managed conservatively without surgery, 10 (18%) with botox treatment, 19 (33%) with surgery, and 8 (14%) with a combination of botox treatment and surgery. Success at 6 months from enrollment was 15% in the conservatively managed cases, 10% with botox alone, 39% with surgery alone, and 25% with a combination of botox and surgery. Conclusions: This study demonstrates that management of chronic Sixth Nerve Palsy and paresis remains challenging. Spontaneous recovery occurs but is uncommon. Botox treatment alone was rarely successful, and a single surgical procedure had a lower-than-expected success rate. Care should be taken in directly comparing success rates between treatment groups because of bias in patient selection. (J AAPOS 2001;5:370-6)
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predictors of nonrecovery in acute traumatic Sixth Nerve Palsy and paresis
Ophthalmology, 2001Co-Authors: Jonathan M Holmes, Roy W Beck, Patrick J Droste, David A LeskeAbstract:Abstract Purpose To evaluate whether nonrecovery from acute traumatic Sixth Nerve Palsy could be predicted from demographic factors or Palsy characteristics. Design Prospective, observational case series Setting Multicenter (academic and private practices). Outcome measure Nonrecovery, defined as the presence of diplopia in primary position or more than 10 prism diopters of distance esotropia in primary position at 6 months after onset. Methods Using data from a previously described cohort of 84 eligible patients with acute traumatic Sixth Nerve Palsy, we performed multivariate analyses of demographic factors and Palsy characteristics. Results Nonrecovery at 6 months after onset was associated with a complete Palsy (adjusted risk ratio, 9.11; 95% confidence interval [CI], 2.77–14.84) and with a bilateral Palsy or paresis (adjusted risk ratio, 2.53; 95% CI, 0.98–4.29). The choice of conservative management (observation, prism, or patch) versus acute injection of Botulinum toxin (within 3 months of injury) did not influence final recovery. Conclusions In acute traumatic Sixth Nerve Palsy or paresis, failure to recover by 6 months after onset was associated independently with inability to abduct past midline at presentation and bilaterality. Although the overall recovery rate is high in acute traumatic Sixth Nerve Palsy or paresis, a complete or bilateral case has a poor prognosis and is more likely to need strabismus surgery.
Mohammadreza Akbari - One of the best experts on this subject based on the ideXlab platform.
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Augmented superior rectus transposition procedure in Duane retraction syndrome compared with Sixth Nerve Palsy
Graefe's Archive for Clinical and Experimental Ophthalmology, 2018Co-Authors: Mohammadreza Akbari, Setareh Shomali, Arash Mirmohammadsadeghi, Masoud Aghsaei FardAbstract:Purpose Superior rectus transposition (SRT) with medial rectus recession has been used for the treatment of Sixth Nerve Palsy and esotropic Duane retraction syndrome (DRS). The purpose of this study was to compare the results of augmented SRT (with scleral fixation) without medial rectus recession in DRS and Sixth Nerve Palsy. Methods Patients with unilateral esotropic DRS (DRS group) and Sixth Nerve Palsy were included in this prospective, comparative study and underwent SRT. Preoperative forced duction testing was negative or slightly positive in both groups. Prospective measurements were compared between the two groups. Results There were 11 patients in the DRS group and 11 patients in the Sixth Nerve Palsy group. The mean preoperative esotropia decreased from 20.9 ± 6.0 prism diopter (PD) at far to 13.2 ± 5.8 PD in the DRS group ( P = 0.003). The same measurement improved from 28.0 ± 8.5 PD to 8.4 ± 7.3 PD in the Sixth Nerve Palsy group ( P = 0.003). In the Sixth Nerve Palsy group, the improvement in primary gaze esotropia and abnormal head posture was more than the DRS group (Both P
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Augmented superior rectus transposition procedure in Duane retraction syndrome compared with Sixth Nerve Palsy.
Graefes Archive for Clinical and Experimental Ophthalmology, 2018Co-Authors: Mohammadreza Akbari, Setareh Shomali, Arash Mirmohammadsadeghi, Masoud Aghsaei FardAbstract:Superior rectus transposition (SRT) with medial rectus recession has been used for the treatment of Sixth Nerve Palsy and esotropic Duane retraction syndrome (DRS). The purpose of this study was to compare the results of augmented SRT (with scleral fixation) without medial rectus recession in DRS and Sixth Nerve Palsy. Patients with unilateral esotropic DRS (DRS group) and Sixth Nerve Palsy were included in this prospective, comparative study and underwent SRT. Preoperative forced duction testing was negative or slightly positive in both groups. Prospective measurements were compared between the two groups. There were 11 patients in the DRS group and 11 patients in the Sixth Nerve Palsy group. The mean preoperative esotropia decreased from 20.9 ± 6.0 prism diopter (PD) at far to 13.2 ± 5.8 PD in the DRS group (P = 0.003). The same measurement improved from 28.0 ± 8.5 PD to 8.4 ± 7.3 PD in the Sixth Nerve Palsy group (P = 0.003). In the Sixth Nerve Palsy group, the improvement in primary gaze esotropia and abnormal head posture was more than the DRS group (Both P
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augmented superior rectus transposition procedure in duane retraction syndrome compared with Sixth Nerve Palsy
Graefes Archive for Clinical and Experimental Ophthalmology, 2018Co-Authors: Mohammadreza Akbari, Setareh Shomali, Arash Mirmohammadsadeghi, Masoud Aghsaei FardAbstract:Superior rectus transposition (SRT) with medial rectus recession has been used for the treatment of Sixth Nerve Palsy and esotropic Duane retraction syndrome (DRS). The purpose of this study was to compare the results of augmented SRT (with scleral fixation) without medial rectus recession in DRS and Sixth Nerve Palsy. Patients with unilateral esotropic DRS (DRS group) and Sixth Nerve Palsy were included in this prospective, comparative study and underwent SRT. Preoperative forced duction testing was negative or slightly positive in both groups. Prospective measurements were compared between the two groups. There were 11 patients in the DRS group and 11 patients in the Sixth Nerve Palsy group. The mean preoperative esotropia decreased from 20.9 ± 6.0 prism diopter (PD) at far to 13.2 ± 5.8 PD in the DRS group (P = 0.003). The same measurement improved from 28.0 ± 8.5 PD to 8.4 ± 7.3 PD in the Sixth Nerve Palsy group (P = 0.003). In the Sixth Nerve Palsy group, the improvement in primary gaze esotropia and abnormal head posture was more than the DRS group (Both P < 0.001).The average dose effect for SRT was 7.8 ± 2.2 PD in the DRS group and 19.2 ± 4.6 PD in the Sixth Nerve Palsy group. Although objective intorsion was significantly induced after SRT, subjective torsion was not significant after surgery in both groups. SRT appears to be more effective in improving primary gaze deviation and head posture in Sixth Nerve Palsy compared with DRS. Subjective torsional and vertical diplopia were rare in both groups.
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Vertical rectus muscle transposition for correcting abduction deficiency in Duane's syndrome type 1 and Sixth Nerve Palsy.
Journal of Pediatric Ophthalmology & Strabismus, 2010Co-Authors: Ziaeddin Yazdian, Mohammad Taher Rajabi, Mohammad Ali Yazdian, Mohammadreza AkbariAbstract:PURPOSE: To report the clinical outcome and complications of the Scott Foster procedure for treating abduction deficiency in patients with Duane's syndrome type 1 and Sixth Nerve Palsy. METHODS: A retrospective, interventional case series included 62 consecutive patients (62 eyes: 38 eyes with Duane's syndrome and 24 eyes with Sixth Nerve Palsy) who underwent the Scott Foster procedure for treatment of abduction deficiency. The main outcome measures were deviation, face turn, and abduction deficiency. RESULTS: In patients with Sixth Nerve Palsy, mean distance deviation improved from 44.7+/-7.2 prism diopters (PD) before surgery to 12.5+/-4.0 PD after surgery (P
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vertical rectus muscle transposition for correcting abduction deficiency in duane s syndrome type 1 and Sixth Nerve Palsy
Journal of Pediatric Ophthalmology & Strabismus, 2009Co-Authors: Ziaeddin Yazdian, Mohammad Taher Rajabi, Mohammad Ali Yazdian, Mohammadreza AkbariAbstract:PURPOSE: To report the clinical outcome and complications of the Scott Foster procedure for treating abduction deficiency in patients with Duane's syndrome type 1 and Sixth Nerve Palsy. METHODS: A retrospective, interventional case series included 62 consecutive patients (62 eyes: 38 eyes with Duane's syndrome and 24 eyes with Sixth Nerve Palsy) who underwent the Scott Foster procedure for treatment of abduction deficiency. The main outcome measures were deviation, face turn, and abduction deficiency. RESULTS: In patients with Sixth Nerve Palsy, mean distance deviation improved from 44.7+/-7.2 prism diopters (PD) before surgery to 12.5+/-4.0 PD after surgery (P<.05), and in patients with Duane's syndrome type 1, mean distance deviation improved from 31.5+/-4.3 PD preoperatively to 9.2+/-3.1 PD. Mean near deviation improved from 27.1+/-4.5 PD to 6.2+/-2.5 PD in patients with Duane's syndrome and from 40.3+/-6.2 PD to 13.7+/-3.4 PD in patients with Sixth Nerve Palsy. Mean abduction deficiency improved from -4 to -2 (P<.05) in both groups. Face turn improved significantly after surgery. No patient had an overcorrection. No recurrence was detected. CONCLUSION: The Scott Foster procedure is effective for improving deviation, abduction deficiency, and face turn in patients with Duane's syndrome type 1 and especially in those with Sixth Nerve Palsy.
David A Leske - One of the best experts on this subject based on the ideXlab platform.
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incidence associations and evaluation of Sixth Nerve Palsy using a population based method
Ophthalmology, 2004Co-Authors: Sanjay V Patel, Srinivas Mutyala, David O Hodge, David A Leske, Jonathan M HolmesAbstract:Abstract Purpose To determine the incidence of Sixth Nerve Palsy in a population-based study, with particular emphasis on associated coexisting medical conditions and to use these data to develop a management algorithm. Design Retrospective, population-based case series. Participants All residents of Olmsted County, Minnesota, USA, diagnosed with Sixth Nerve Palsy between January 1, 1978 and December 31, 1992. Methods All cases were identified by using the Rochester Epidemiology Project medical records linkage system, which captures all patient-physician encounters in Olmsted County. The entire medical record of each patient was reviewed to confirm the diagnosis, document county residency, and to determine associated medical conditions. We used stringent predetermined criteria to define diabetes mellitus and hypertension as associations. Incidence rates were adjusted to the age and gender distribution of the 1990 white population in the United States. Main outcome measures Etiology or systemic associations of the Palsy. Results We identified 137 new cases of Sixth Nerve Palsy over the 15-year period. The age- and gender-adjusted annual incidence of Sixth Nerve Palsy was 11.3/100 000 (95% confidence interval, 9.3–13.2/100 000). Causes and associations were: undetermined (26%), hypertension alone (19%), coexistent hypertension and diabetes (12%), trauma (12%), multiple sclerosis (7%), neoplasm (5%), diabetes alone (4%), cerebrovascular accident (4%), postneurosurgery (3%), aneurysm (2%), and other (8%). When Sixth Nerve Palsy was the presenting sign in cases of neoplasm (n = 1) and aneurysm (n = 3), history and examination revealed the presence of other neurologic symptoms or signs. Conclusions We provide population-based data on the incidence of Sixth Nerve Palsy with a notably lower incidence of neoplasm and higher incidence of diabetes and hypertension than previous institution-based series. We suggest that patients with nontraumatic neurologically isolated Sixth Nerve Palsy may undergo a focused medical evaluation followed by close observation, whereas non–neurologically isolated cases warrant a full neurologic evaluation, including prompt neuroimaging.
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long term outcomes after surgical management of chronic Sixth Nerve Palsy
Journal of Aapos, 2002Co-Authors: Jonathan M Holmes, David A LeskeAbstract:Background: In a multicenter prospective data collection study of chronic Sixth cranial Nerve Palsy, we previously reported that the initial successful outcome rate was 39% after a single surgical intervention and 25% after surgery combined with botulinum toxin (Botox), using strict success criteria. We now report the longer term outcome of these patients. Methods: A previously described cohort of 31 patients in 18 centers who underwent strabismus surgery for a Sixth Nerve Palsy of greater that 6 months duration was studied prospectively. Twenty-three had strabismus surgery alone and 8 surgery with Botox. Fourteen (45%) were complete palsies and 17 (55%) were incomplete. Seven (23%) were bilateral and 24 (77%) were unilateral. Outcome was classified at time of last follow-up, which was 5 weeks to 24 months postoperatively. Success was defined as no diplopia in primary position at distance fixation. Partial success was defined as no more than 10 PD esotropia despite diplopia. Results: Overall, 16 (52%) of the patients were classified as successes, 7 (23%) as partial successes, and 8 (25%) as failures. Three (43%) of the partial successes were using prism. Eight (35%) of the patients classified as successes or partial successes required 2 surgical procedures. Of all patients (10, 32%) who had a second surgery, only 2 (20%) remained failures. Conclusions: Despite our reported poor initial surgical success rate in chronic Sixth Nerve Palsy, additional strabismus surgery, longer follow-up, and the use of prism or face turn for small residual deviations yields an overall surgical success rate of 75%. More than 1 surgical procedure and prism are often necessary in the management of chronic Sixth Nerve Palsy. (J AAPOS 2002;6:283-8)
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initial treatment outcomes in chronic Sixth Nerve Palsy
Journal of Aapos, 2001Co-Authors: Jonathan M Holmes, David A Leske, Stephen P ChristiansenAbstract:Introduction: We conducted a prospective multi-center, nonrandomized, data-collection study of patients with chronic Sixth cranial Nerve Palsy. We evaluated success rates with conservative nonsurgical management, botulinum toxin (botox) treatment, strabismus surgery, and a combination of botox treatment and surgery. Methods: All members of the American Association for Pediatric Ophthalmology and Strabismus and the North American NeuroOphthalmology Society were invited to enroll patients with Sixth Nerve Palsy or paresis of more than 6 months duration over a 2-year period (between March 1998 and February 2000). The botox and surgical groups received intervention within 3 months of enrollment. Success at 6 months from enrollment was defined as absence of diplopia in primary position and no more than 10 prism diopters (pd) distance esotropia in primary position. Patients with no follow-up were excluded. Results: Fifty-six eligible patients were enrolled by 33 investigators. Eighteen (32%) were traumatic in etiology, 15 (27%) were unknown (including presumed hypertensive), 14 (25%) were neoplastic, 2 (4%) were diabetic, and 7 (13%) were other. Twenty (35%) were managed conservatively without surgery, 10 (18%) with botox treatment, 19 (33%) with surgery, and 8 (14%) with a combination of botox treatment and surgery. Success at 6 months from enrollment was 15% in the conservatively managed cases, 10% with botox alone, 39% with surgery alone, and 25% with a combination of botox and surgery. Conclusions: This study demonstrates that management of chronic Sixth Nerve Palsy and paresis remains challenging. Spontaneous recovery occurs but is uncommon. Botox treatment alone was rarely successful, and a single surgical procedure had a lower-than-expected success rate. Care should be taken in directly comparing success rates between treatment groups because of bias in patient selection. (J AAPOS 2001;5:370-6)
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predictors of nonrecovery in acute traumatic Sixth Nerve Palsy and paresis
Ophthalmology, 2001Co-Authors: Jonathan M Holmes, Roy W Beck, Patrick J Droste, David A LeskeAbstract:Abstract Purpose To evaluate whether nonrecovery from acute traumatic Sixth Nerve Palsy could be predicted from demographic factors or Palsy characteristics. Design Prospective, observational case series Setting Multicenter (academic and private practices). Outcome measure Nonrecovery, defined as the presence of diplopia in primary position or more than 10 prism diopters of distance esotropia in primary position at 6 months after onset. Methods Using data from a previously described cohort of 84 eligible patients with acute traumatic Sixth Nerve Palsy, we performed multivariate analyses of demographic factors and Palsy characteristics. Results Nonrecovery at 6 months after onset was associated with a complete Palsy (adjusted risk ratio, 9.11; 95% confidence interval [CI], 2.77–14.84) and with a bilateral Palsy or paresis (adjusted risk ratio, 2.53; 95% CI, 0.98–4.29). The choice of conservative management (observation, prism, or patch) versus acute injection of Botulinum toxin (within 3 months of injury) did not influence final recovery. Conclusions In acute traumatic Sixth Nerve Palsy or paresis, failure to recover by 6 months after onset was associated independently with inability to abduct past midline at presentation and bilaterality. Although the overall recovery rate is high in acute traumatic Sixth Nerve Palsy or paresis, a complete or bilateral case has a poor prognosis and is more likely to need strabismus surgery.
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botulinum toxin treatment versus conservative management in acute traumatic Sixth Nerve Palsy or paresis
Journal of Aapos, 2000Co-Authors: Jonathan M Holmes, Roy W Beck, Patrick J Droste, David A LeskeAbstract:Abstract Purpose: Botulinum toxin (BTX), injected into the ipsilateral medial rectus muscle, has been advocated for the management of acute traumatic Sixth Nerve Palsy or paresis. We conducted a multicenter, nonrandomized, data collection study to evaluate recovery rates of patients treated with either conservative measures or BTX. Methods: All members of the American Association for Pediatric Ophthalmology and Strabismus and the North American Neuro-Ophthalmology Society were invited to enroll patients with acute traumatic Sixth Nerve Palsy or paresis during a 2-year period (between March 1996 and February 1998). The BTX group was defined as patients who received a BTX injection within 3 months of injury. Recovery at 6 months from injury was defined as absence of diplopia in the primary position and a distance esotropia of no more than 10 PD in the primary position. Nonrecovered patients with less than 6 months of follow-up (n = 15) were excluded. Results: Eighty-four eligible patients were enrolled by 46 investigators. Sixty-two patients (74%) were treated conservatively and 22 (26%) with BTX. Sixty-two patients (74%) had unilateral Palsy, and 22 (26%) had bilateral Palsy. Recovery rates were similar between BTX and conservatively treated patients (overall: 73% vs 71%, P = 1.0; unilateral: 81% vs 83%, P = 1.0; bilateral: 50% vs 38%, P = 0.66, respectively). Conclusions: In this prospective multicenter study of acute traumatic Sixth Nerve Palsy or paresis, patients treated with either BTX or conservative measures had similar high recovery rates. (J AAPOS 2000;4:145–9)
Michael C. Brodsky - One of the best experts on this subject based on the ideXlab platform.
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Vertical rectus muscle transposition with intraoperative botulinum injection for treatment of chronic Sixth Nerve Palsy
Graefe's Archive for Clinical and Experimental Ophthalmology, 1990Co-Authors: James W. Mcmanaway, Edward G. Buckley, Michael C. BrodskyAbstract:Six adult patients with acquired, chronic, complete Sixth Nerve Palsy had vertical rectus muscle transposition to the lateral rectus muscle insertion with intraoperative injection of botulinum toxin into the ipsilateral medial rectus muscle. Five of six patients were orthophoric in primary gaze, and the remaining patient achieved single binocular vision with a small head turn. This method compares favorably with previously described transposition procedures for Sixth Nerve Palsy in terms of amount of correction and size of the window of single binocular vision with a lower risk of anterior segment ischemia.
Straton Tyradellis - One of the best experts on this subject based on the ideXlab platform.
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A Modified Surgical Technique to Treat Strabismus in Complete Sixth Nerve Palsy
Ophthalmology and Therapy, 2018Co-Authors: Nikolaos Kozeis, Magdalini Triantafylla, Aspasia Adamopoulou, Stergiani Veliki, Athina Kozei, Straton TyradellisAbstract:Introduction A lot of different techniques have been proposed in order to manage abduction limitation secondary to Sixth Nerve Palsy; however, anterior segment ischemia remains a concern. The aim of this study was to evaluate the results of augmented vertical recti muscle transposition (VRT) with partial recession of medial rectus muscle (MR) for complete, chronic Sixth Nerve Palsy, a new modified technique that could also minimize the risk for anterior segment ischemia (ASI). Methods In this nonrandomized 8-year (2009–2017) retrospective review, 20 patients with complete Sixth Nerve Palsy and contracted MR were enrolled. All of them underwent augmented VRT and partial recession of the MR, following a new proposed surgical technique. Only the central part of the MR tendon and belly was recessed by 6.5 mm, leaving 1.5 mm of the upper pole and 1.5 mm of the lower pole of the muscle intact, preserving the circulation of two anterior ciliary arteries. Results Twenty patients with a mean age of 43 years (range 12–71), all unilateral cases, were enrolled in this study. The mean preoperative deviation was 64.25 ± 10.9 prism diopters (PD) base out (range 50 to 90). In 17 cases (88%), the postoperative deviation was within 10 PD of orthotropia. Two patients (10%) had residual esotropia (15 PD and 20 PD, respectively), and one patient (5%) had 10 PD of hypotropia. The mean preoperative abduction limitation of −5.9 improved to −3.1 ( p
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A Modified Surgical Technique to Treat Strabismus in Complete Sixth Nerve Palsy.
Ophthalmology and therapy, 2018Co-Authors: Nikolaos Kozeis, Magdalini Triantafylla, Aspasia Adamopoulou, Stergiani Veliki, Athina Kozei, Straton TyradellisAbstract:INTRODUCTION: A lot of different techniques have been proposed in order to manage abduction limitation secondary to Sixth Nerve Palsy; however, anterior segment ischemia remains a concern. The aim of this study was to evaluate the results of augmented vertical recti muscle transposition (VRT) with partial recession of medial rectus muscle (MR) for complete, chronic Sixth Nerve Palsy, a new modified technique that could also minimize the risk for anterior segment ischemia (ASI). METHODS: In this nonrandomized 8-year (2009-2017) retrospective review, 20 patients with complete Sixth Nerve Palsy and contracted MR were enrolled. All of them underwent augmented VRT and partial recession of the MR, following a new proposed surgical technique. Only the central part of the MR tendon and belly was recessed by 6.5 mm, leaving 1.5 mm of the upper pole and 1.5 mm of the lower pole of the muscle intact, preserving the circulation of two anterior ciliary arteries. RESULTS: Twenty patients with a mean age of 43 years (range 12-71), all unilateral cases, were enrolled in this study. The mean preoperative deviation was 64.25 ± 10.9 prism diopters (PD) base out (range 50 to 90). In 17 cases (88%), the postoperative deviation was within 10 PD of orthotropia. Two patients (10%) had residual esotropia (15 PD and 20 PD, respectively), and one patient (5%) had 10 PD of hypotropia. The mean preoperative abduction limitation of -5.9 improved to -3.1 (p