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Mana Okamoto; Features of ocular motility disorders due to traffic accidents requiring extraocular muscle surgery. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2930.
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© ARVO (1962-2015); The Authors (2016-present)
To report features of ocular motility disorders due to traffic accidents requiring extraocular muscle surgery.
Seventy-nine patients (male:41, female:38, mean age: 49.2 years) with ocular motility disorders due to traffic accidents who underwent extraocular muscle surgery over the past 5 years at Hyogo College of Medicine Hospital, Japan were included in this study. The surgery was designed to render the eye position orthophoric at the primary position. Adjustment surgery, when necessary, was performed on the day following the first operation, and was included in the first series of operations. We investigated retrospectively the backgrounds of the cases, the types of operation, the numbers of operations, and the surgical results.
The causes of strabismus were as follows: 42 cases of trochlear nerve palsy (53.2%), 20 cases of oculomotor nerve palsy (25.3%), 5 cases of abducens nerve palsy (6.3%), 5 cases of restrictive strabismus (6.3%), and 7 cases of other types (8.9%). Secondary brain injury was observed in 32 cases (40.5%). The period from onset to surgery was 51.3 ± 82.1 months. Preoperatively, diplopia was present in 72 cases (91.1%), and abnormal head posture was present in 39 cases (54.2%). The procedures were nasal transposition of inferior rectus muscle (IR) (30 cases), horizontal rectus muscle recession / resection (14 cases), horizontal rectus muscle surgery with IR nasal transposition (10 cases), muscle transposition (10 cases), oblique muscle surgery (6 cases), vertical rectus muscle with horizontal rectus muscle surgery (5 cases), and other procedures (4 cases). Adjustment surgery was done in 22 cases (27.8%), and reoperation in 17 cases (21.5%). Diplopia was eliminated in 56 cases (77.8%) by surgery alone, and in 59 cases (81.9%) by surgery plus prism therapy. The diplopia cure rates by causes of strabismus were as follows: trochlear nerve palsy 82.5%, oculomotor nerve palsy 66.7%, abducens nerve palsy 80%, and restrictive strabismus 100%, and were not statistically different among the causes of strabismus (p = 0.4234). Abnormal head posture was improved in 32 cases (82.1%) after surgery.
Strabismus after traffic accidents accounted for a majority of paralytic strabismus cases (91.1%), but extraocular muscle surgery is effective in the effort to improve diplopia and abnormal head posture.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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