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Recession–resection combined with intraoperative botulinum toxin A chemodenervation for exotropia following subtotal ruptured of medial rectus muscle

Authors
 Samin Hong  ;  Hyung Keun Lee  ;  Sueng-Han Han  ;  Jong Bok Lee 
Citation
 GRAEFES ARCHIVE FOR CLINICAL AND EXPERIMENTAL OPHTHALMOLOGY, Vol.245(1) : 167-169, 2007 
Journal Title
 GRAEFES ARCHIVE FOR CLINICAL AND EXPERIMENTAL OPHTHALMOLOGY 
ISSN
 0721-832X 
Issue Date
2007
MeSH
Botulinum Toxins, Type A/administration & dosage* ; Child ; Combined Modality Therapy ; Exotropia/etiology ; Exotropia/therapy* ; Eye Injuries/diagnostic imaging ; Eye Injuries/etiology ; Eye Injuries/therapy* ; Female ; Humans ; Intraoperative Care ; Neuromuscular Agents/administration & dosage* ; Oculomotor Muscles/injuries* ; Oculomotor Muscles/innervation ; Ophthalmologic Surgical Procedures ; Rupture ; Sympathectomy, Chemical ; Tomography, X-Ray Computed ; Wounds, Nonpenetrating/complications* ; Wounds, Nonpenetrating/diagnostic imaging
Abstract
BACKGROUND: Ruptured extraocular muscle loses its function and shows severe restriction of eye movement even after muscle-to-muscle anastomosis or muscle transposition surgery. We present the case of a patient who developed a large exotropia after near-total rupture of the medial rectus muscle following a blowout fracture. METHODS: Case report. RESULTS: A 12-year-old girl presented at our clinic with 45 prism diopters' exotropia after a blunt trauma. A forced duction test was unrestricted, and orbital computed tomography showed a medial orbital wall fracture and an impinged medial rectus muscle. Upon surgical exploration, an almost totally ruptured medial rectus muscle was found. The median margin of the ruptured muscle was 6.0 mm from its insertion, and the distal end that we could examine was 15.0 mm from the limbus. Recession-resection surgery combined with intraoperative botulinum toxin A chemodenervation to the ipsilateral lateral rectus muscle achieved a good primary alignment and binocular single visual field, even at a 9-month follow-up. CONCLUSIONS: Recession-resection surgery augmented by intraoperative botulinum toxin A chemodenervation to the ipsilateral rectus muscle appears to be highly effective in the treatment of a large exotropia produced by subtotal rectus muscle rupture following orbital wall fracture, with a lower risk of anterior segment ischemia.
Full Text
http://link.springer.com/article/10.1007%2Fs00417-005-0226-x
DOI
10.1007/s00417-005-0226-x
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Ophthalmology (안과학교실) > 1. Journal Papers
Yonsei Authors
Lee, Jong Bok(이종복)
Lee, Hyung Keun(이형근) ORCID logo https://orcid.org/0000-0002-1123-2136
Han, Seung Han(한승한) ORCID logo https://orcid.org/0000-0001-8972-4790
Hong, Sa Min(홍사민)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/96058
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