Toshio Maruo

Results of Surgery for Paralytic Exotropia due to Oculomotor Palsy

In 138 cases of paralytic exotropia due to oculomotor palsy, transposition of the superior oblique muscle and resection of the medial rectus muscle were carried out. Surgery was performed with or without recession of the lateral rectus muscle. The long-term prognosis for 4 years or more was observed in 35 cases. We found that the same results could be obtained by selecting transposition of the superior oblique muscle in cases of complete palsy and resection of the medical rectus muscle in cases of incomplete palsy. There was no benefit in combining resection of the medial rectus muscle when performing the transposition of the superior oblique muscle. Regardless of which method was used, a combination with recession of the lateral rectus muscle greatly improved the effectiveness of the procedure.

Recurrent Mutation of the KIF21A Gene in Japanese Patients with Congenital Fibrosis of the Extraocular Muscles

PurposeTo report recurrent mutation of the KIF21A gene in three Japanese families in which some members have congenital fibrosis of the extraocular muscles type 1 (CFEOM1), and to describe the clinical characteristics of the families.MethodsStandard ocular examinations were performed on 18 normal and affected members of three unrelated families. To detect mutations, we determined the DNA sequence of exons 8, 20, and 21 and the splice sites of the KIF21A gene.ResultsAll affected members had a heterozygous mutation of the KIF21A gene in exon 21 (R954W). Clinically, each patient had congenital bilateral ptosis, an infraducted primary position of each eye, and the inability to raise either eye above midline.ConclusionsThe KIF21A gene mutation R954W was detected in the patients with CFEOM1 screened in this study, all of whom were Japanese, reflecting similar reports from Europe, America, the Middle East, and Japan. We suggest that mutations of the KIF21A gene contribute to the development of CFEOM1 regardless of ethnicity. We also found that the delimitation of the KIF21A gene mutation site enabled us to efficiently detect the KIF21A gene mutation despite the large number of KIF21A gene exons. Jpn J Ophthalmol 2005;49:443–447

Outcome of Surgery for Bilateral Third Nerve Palsy

PURPOSE To review the outcome of surgery for bilateral third nerve palsy. METHODS The series comprised 16 cases. The eye deviation in the primary position averaged -27.0 degrees horizontally. Surgery was aimed at bringing both eyes into alignment in the primary position by recession-resection of horizontal muscles. Transposition of the superior oblique was performed for complete third nerve palsy. Surgery was initially performed on the nonfixating eye. The fellow eye underwent further surgery for residual disorders. RESULTS Within 6 months after surgery, the eye deviation in the primary position averaged -0.7 degrees horizontally. After longer follow-up, the eye deviation averaged -4.7 degrees horizontally. Postoperatively, diplopia in the primary position was absent in 11 and remained in 5 cases. CONCLUSION Surgery for bilateral third nerve paresis or palsy achieved lasting cosmetic or functional improvements in the majority of cases.

Skew Transposition of Vertical Rectus Muscles for Excyclovertical Deviation

PURPOSE The authors established a surgical treatment for excyclovertical strabismus in which either the inferior rectus muscle or the superior rectus muscle was transposed diagonally. The effects and the safety of the procedure, called skew transposition, were studied. METHODS Eighteen operations using local anesthesia with eye drops were performed on 17 cases, including 10 with superior oblique palsy. Diplopia was checked during the operation with the cooperation of each patient. Both the clinical findings and eye deviation were examined during observation periods. RESULTS After the first operation, the diplopia in the primary position had disappeared in 10 cases and had improved in the other 7. The average effect of all operations on excyclodeviation was a correction of 6.2 degrees in the primary position. In the 7 cases of superior oblique palsy that received nasal recession of the inferior rectus muscle, the average correction of excyclodeviation was 6.4 degrees, and vertical deviation improved 1.8 degrees per 1 mm of recession. In no case did the diplopia worsen, nor were there any complications. CONCLUSIONS This safe procedure facilitates the simultaneous improvement of both excyclo- and vertical deviations. It may become the treatment of choice for excyclovertical strabismus.

Acquired Progressive Esotropia and Acquired Strabismus Fixus

BACKGROUND AND PURPOSE We previously reported on acquired convergent strabismus fixus and its incomplete type of esodeviation, which we named acquired progressive esotropia. In this study, we tried to confirm that the esotropia was acquired and progressive and to determine the most appropriate surgical procedure. SUBJECTS AND METHODS Forty-three cases, 32 of acquired progressive esotropia and 11 of acquired convergent strabismus fixus with severe myopia, were rechecked to evaluate their clinical and physiological features. Thirty-seven cases underwent strabismus surgery and the surgical results were also evaluated. RESULTS We obtained positive proof that the esodeviation was an acquired situation and progressed into convergent strabismus fixus from some pictures at a young age. The condition of some of these patients developed into convergent strabismus fixus in a short time. Combined recession-resection operation and transposition of superior and inferior rectus muscles were effective for the patients without severe abducting disorders. CONCLUSION We must make a certain diagnosis of progressive esotropia in the early stages, because the condition of some of these patients will develop into strabismus in a short time if we miss the appropriate time for surgery.

Surgery for Strabismus Secondary to Ethmoid Sinus Surgery

PurposeTo review the outcome of surgery for strabismus due to ethmoid sinus surgery.Cases and MethodsThe series comprised 13 cases, 1 of inferior rectus paresis, 1 of superior oblique paresis, 6 of medial rectus paresis, and 5 of medial rectus muscle palsy due to third nerve palsy. In the cases of paresis of the rectus muscle, resection of the rectus muscles was mainly performed. In the cases of palsy of the rectus muscle, transposition of the extraocular muscle with simultaneous recession of the lateral rectus muscle was performed. The major aim of surgery was to bring both eyes into alignment and to eliminate diplopia in the primary position.ResultsThe mean preoperative horizontal deviation of 18.1 degrees of exotropia in the paresis cases was reduced to 1.4 degrees of exotropia after surgery. The mean preoperative vertical deviation of 3.8 degrees of hypertropia was reduced to 1.4 degrees of hypertropia postoperatively. The mean preoperative horizontal deviation of 35.6 degrees of exotropia in the palsy cases was reduced to 9.4 degrees of exotropia after surgery. The mean preoperative vertical deviation of 2.0 degrees of hypertropia was increased to 2.6 degrees of hypertropia postoperatively. Postoperatively, diplopia was absent in 11 cases with a slightly compensatory head posture.ConclusionsSurgery for strabismus due to sinus surgery induces improvements in eye position and diplopia. Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc 107:425–432, 2003)

Binocular Function of Intermittent Exotropia Before and After Surgery

PURPOSE We examined the binocular function of intermittent exotropia before and after surgery, and studied the effect of the surgery and the factor that might be involved in its result. MATERIALS AND METHODS 402 intermittent exotropic patients, who underwent their first surgical correction for the strabismus at Teikyo University Hospital, were examined for retinal correspondence and stereo acuity before and after surgery. RESULTS 367 patients (91.3%) had already had good stereo acuity before surgery when their eyes were straight. Regarding retinal correspondence, though 192 patients (47.8%) were abnormal (dual) before surgery, 301 patients (74.9%) were normal after surgery. The eye deviation of 101 patients who could not get normal retinal correspondence after surgery was significantly larger than normal (p < 0.001), and 77.2% of them had also vertical strabismus which was mainly composed of dissociated vertical deviation. CONCLUSION Normal binocular function could be recovered by surgical treatment in most intermittent exotropic patients. When patients could not get normal retinal correspondence after surgery, we supposed that dissociated vertical deviation might exert an important effect upon their binocular function.

Outcome of surgery for bilateral third nerve disorder

PURPOSE To review the outcome of surgery for bilateral third nerve palsy. CASES AND METHODS The series comprised 16 cases. The eye deviation in the primary position averaged -27.0 degrees horizontally. Surgery was aimed at bringing both eyes into alignment in the primary position by recession-resection of the horizontal muscles. Transposition of the superior oblique was performed for complete third nerve palsy. Surgery was initially performed on the nonfixating eye. The fellow eye received further surgery for residual disorders. RESULTS Within 6 months after surgery, the eye deviation in the primary position averaged -0.7 degrees horizontally. After longer follow-up, the eye deviation averaged -4.7 degrees horizontally. Postoperatively, diplopia in the primary position was absent in 11 and present in 5 cases. CONCLUSION Surgery for bilateral third nerve paresis or palsy induced lasting cosmetic or functional improvements in the majority of cases.

Clinical Characteristics of Non-accommodative Intermittent Esotropia

We recently encountered cases of non-accommodative esotropia with intermittent esotropia observed in both far and near vision; good visual acuity and binocular visual function; variation in strabismic angle; and abnormalities on electroencephalogram (EEG). Although non-accommodative esotropia has been studied by Costenbader [1] and von Noorden [2] et al., its signs and symptoms have not been fully clarified. Therefore, we studied 17 patients with non-accommodative intermittent esotropia with common clinical symptoms (age: 3–14 years), and recognized these cases as representing new clinical entity.