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F. A. Escalante-Razo; "Eye To Eye" Traction Suture, A New Approach for VI and III Nerve Palsies Treatment. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5286.
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To improve a new treatment for the III and VI nerve palsies to avoid diplopia and rescue some of the lost movements when the palsy is adquired.
To join the health eye to the palsy one with a traction suture to make the first one pulls the second improving the palsy's movements.
This technique permits an improvement of the movements of the palsy eye, and also puts the two eyes near to orthotropia.
It is a new approach for the management of a VI or III nerve palsies. It needs an improvement of the knots to avoid consecutive or residual deviations.A new surgical technique for the management of VI or III nerve palsies to avoid diplopia and recover some movement of the palsy's, using an "eye to eye traction suture" that is based in the capacity of the eye to move with low resistence (having more muscular forces than the necessary), joining both eyes, looking for the healthy's movements pull and move the contralateral eye.This case is an adquired VI nerve palsy in an adult male (concussion) with diplopia and esotropia, having no abduction on the left eye.The steps are as following:1. One incision in both sides of the nasal piramyd 5 mm medial to the internal eyelid vertex has been made.2. Dissection in both sides until reach the periostium.3. Perforation of the nasal bones with a trocar to connect both incisions.4. Two silicone tubes are colocated inside the perforation, one of them from the right side and the other from the left one. The silicone tubes needs to have a nylon 5-0 or 6-0 suture inside.5. Both silicone tubes needs to be deep to make a tunnel, penetrating the orbit back the conjunctive at the carunculla.6. Dissection of the conjunctive like a traditional strabismus surgery of the internal extraocular muscle has been made. The two silicone tubes are expose near the muscle insertion.7. Both nylon sutures makes a knot at the sclera near to the ecuatorial line (in the III nerve palsy cases the nylon needs to be approached to the limbus). This is made in both sides, alignning the two eyes.The first two weeks the patient has no diplopia, but at the third the esotropia becomes noticeable again, also the diplopia.The residual deviation was treated by the use of a prismatic glasses.
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