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Author Notes:

Correspondence: Amy K. Hutchinson, MD, 1365B N. Clifton Road, NE, Atlanta, GA 30322 (amy.hutchinson@emory.edu).

Subject:

Research Funding:

Supported in part by an unrestricted grant to the Emory Eye Center from Research to Prevent Blindness, Inc, New York, New York.

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Ophthalmology
  • Pediatrics
  • RECTUS MUSCLE TRANSPOSITION
  • BOTULINUM TOXIN
  • PARALYTIC STRABISMUS
  • DUANE-SYNDROME
  • MEDIAL RECTUS
  • SURGERY
  • SUTURE

Augmented Hummelsheim procedure to treat complete abducens nerve palsy

Tools:

Journal Title:

Journal of AAPOS

Volume:

Volume 16, Number 4

Publisher:

, Pages 331-335

Type of Work:

Article | Post-print: After Peer Review

Abstract:

Background: Horizontal strabismus due to a weak rectus muscle can be treated with an augmented Hummelsheim procedure, in which both vertical rectus muscle tendons are split, resected by 4 mm, and reattached to the sclera adjacent to the weak rectus muscle. Compared with vertical rectus transposition, the procedure spares two ciliary vessels and does not require placement of augmentation sutures. In this study, we evaluated binocular alignment and ocular motility in patients with abducens nerve palsy treated with an augmented Hummelsheim procedure. Methods: The medical records of consecutive patients with complete abducens nerve palsy who underwent the augmented Hummelsheim procedure, usually combined with medial rectus muscle recession, were retrospectively reviewed. Binocular alignment, ocular motility, and complications were analyzed. Results: Ten patients (age range, 12-57 years) met inclusion criteria for the study, of whom 9 of 10 had simultaneous medial rectus recession. Follow-up ranged from 1 week to 24 months. The augmented Hummelsheim procedure improved esotropia from 43Δ ± 5 Δ preoperatively to 6Δ ± 7 Δ postoperatively (P < 0.0001) and reduced abduction deficits from -4 to -3 (P < 0.0001). One patient with coexisting oculomotor nerve palsy developed consecutive exotropia; 2 had induced vertical deviations. There were no cases of anterior segment ischemia. Conclusions: The augmented Hummelsheim procedure combined with medial rectus muscle recession reduced mean primary position esotropia and improved abduction in patients with complete abducens nerve palsy.

Copyright information:

© 2012 by the American Association for Pediatric Ophthalmology and Strabismus.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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