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Shannon M. Daniel, Michael Flanders; Pontine Lesions And Abducens Nerve Palsy:clinical Presentation And Surgical Management. Invest. Ophthalmol. Vis. Sci. 2011;52(14):6367.
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To discuss the clinic presentation and surgical management of selected patients with pontine gaze palsy and abducens paralysis secondary to brain stem insults (hemorrhage, infarct or tumour).
Four patients (age range 15-60 years), were referred for evaluation of a gaze palsy with associated ipsilateral abducens paresis of pontine origin. They were all previously examined and investigated by the neurology services. The patients had full ophthalmological and orthoptic assessments. All patients had strabismus surgery to improve the gaze palsy and associated torticollis and to eliminate the esotropia with its related diplopia. In 2 patients, a complete transposition of the vertical muscles temporally was combined with Botox injection into the ipsilateral medial rectus muscle. This was followed by a supramaximal recession of the ipsilateral medial rectus muscle at a later date. The third patient had horizontal muscle surgery to strengthen the medial rectus and fellow yolk lateral rectus muscles to reduce the gaze palsy and medial rectus recession on the side of the VIth nerve palsy. The ipsilateral medial rectus muscle was injected intraoperatively with Botox in 2 of the patients.
The results of our study confirm that an improvement of diplopia in primary gaze and compensatory head position is possible with strabismus surgery for patients with complex ocular motility disorders secondary to pontine lesions. The aim of surgery is to improve diplopia in primary gaze, compensatory head position and cosmesis
Pontine lesions that involve the PPRF, VI N nucleus and VII N nucleus cause characteristic findings which include:Ipsilateral gaze palsy,slow saccades toward the side of the lesion, gaze evoked nystagmus to the contralateral side, ipsilateral abducens paralysis, and ipsilateral facial palsy. Single binocular vision, improved compensatory head turn and cosmesis are achievable with strabismus surgery
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