Explore the vast range of titles available.

Introduction: The aims of the study were to report a rare case of isolated idiopathic inferior rectus (IR) palsy in a young adult and discuss its clinical features, diagnostic workup, and surgical management. Case Presentation: A 31-year-old male presented with a 3-month history of vertical diplopia and right hypertropia. Comprehensive ophthalmic and systemic evaluations, including imaging and laboratory tests, were conducted. Examinations revealed right IR underaction with a 30 prism diopter hypertropia in primary gaze. Forced duction testing was negative. Imaging and laboratory investigations were unremarkable. The patient underwent an 8-mm ipsilateral superior rectus (SR) recession. Postoperatively, orthotropia was achieved with resolution of diplopia. Conclusions: Isolated idiopathic IR palsy is exceedingly rare. Thorough evaluation is essential to exclude secondary causes. Ipsilateral SR recession can provide excellent functional and cosmetic outcomes in patients with persistent hypertropia and diplopia.

Multiple transposition procedures have been described for management of lateral rectus palsy. However, relative effect and indications of each procedure are unclear. This systematic review was planned to evaluate functional and anatomical outcomes of vertical rectus transposition (VRT) surgery in patients with lateral rectus palsy. We searched databases in English language, namely, MEDLINE, PubMed Central, EMBASE, Google Scholar, Scopus, and Index Copernicus without any date restrictions in electronic searches, using the search words 'vertical rectus transposition for lateral rectus palsy,\" \"vertical rectus transposition for abducens palsy,\" \"superior rectus transposition,\" \"inferior rectus transposition,\" and \"Hummelsheim procedure.\" References of the selected publications were also searched to find any relevant studies. We searched for studies that provided data on single VRT and double VRT surgeries for lateral rectus palsies. Three authors independently assessed the related studies gathered from electronic and manual searches. We found 27 studies which were relevant to the review question. As there were no randomized control trials (RCTs) available related to our study question, nonrandomized studies were used to arrive at summarization of outcomes of different transposition procedures. There is a need for prospective RCTs to investigate the different types of transposition procedures for lateral rectus palsy.

The aim of this work is to elucidate underlying etiologies, lesion locations, and outcomes of inferior rectus (IR) palsy of acquired origin. Retrospective search identified 44 patients with acquired IR palsy between April 2006 and May 2011 from four Neurology and two Ophthalmology Clinics in Korea. We analyzed clinical features, the results of radiological and laboratory evaluation, and prognosis. The most common causes were vascular ( n  = 16, 36 %) and trauma ( n  = 12, 27 %). Vascular disorders included microvascular ischemia ( n  = 10, 23 %), cerebral infarction ( n  = 5, 11 %), and dural arterio-venous fistula ( n  = 1, 2 %). Other causes were inflammation ( n  = 7, 16 %), myasthenia gravis ( n  = 5, 11 %), and thyroid ophthalmopathy ( n  = 1, 2 %). We were unable to determine the etiology in the remaining three patients (7 %). Most patients (95 %) showed a complete recovery with or without treatment. Acquired IR palsy mostly occurs with brainstem or orbital lesions, and has an excellent prognosis.

Background Neuromuscular hamartoma is a very rare tumor; with only five cases reported in the orbit. It often occurs in infants and young children and involves large peripheral nerves, but there has been only few reports of occurrence in the orbit and adults. Case presentation This paper describes a 70-year-old man with an incidental orbital mass detected by an imaging test and who later developed associated symptoms. The mass was diagnosed as neuromuscular hamartoma. Superior rectus muscle recession and inferior rectus muscle resection were performed in the right eye for hypertropia secondary to postoperative inferior rectus muscle palsy. Hypertropia in the right eye and diplopia improved after surgery, and regular follow-up is underway. Conclusion This is the first case of an incidentally detected orbital mass diagnosed by histologic examination as a neuromuscular hamartoma in an older patient whose proptosis progressed after a long period of inactivity.

Background to report the results of augmented inferior rectus muscle transposition (IRT) in management of chronic sixth nerve palsy. Methods a retrospective review of medical records of patients with chronic complete sixth nerve palsy who were treated by augmented full thickness IRT to the lateral border of the paralyzed lateral rectus muscle. Patients were selected for IRT if there was more limitation of abduction in inferior gaze associated with V- pattern esotropia. Medial rectus recession (MRRc) was performed in case of positive intraoperative forced duction. Effect on primary position esotropia, face turn, amount of V-pattern and limitation of ocular ductions were reported and analyzed. Results the review revealed 11 patients (7 males) with chronic unilateral sixth nerve palsy who were treated by simultaneous augmented IRT and MRRc. Causes of sixth nerve palsy were trauma (6 cases), vascular (3 cases), inflammation and congenital (one case each). Mean age of the patients at the time of surgery was 35.6 years (range; 11–63) and mean follow up was 8.6 months (range; 6–13). Postoperatively, average correction of esotropia, V-pattern, face turn and limited abduction were 35.9 PD, 11.4 PD, 25.9° and 2.2 unit, respectively ( p  < .00). Postoperative complications in the form anterior segment ischemia, symptomatic induced vertical deviations were not found. Conclusions In cases of chronic unilateral sixth nerve palsy associated with more limitation of abduction in downgaze and V-pattern esotropia, augmented IRT could be considered as an effective and safe modality.

Purpose Evaluate and analyze the efficacy of inferior oblique belly transposition (IOBT) in treating adult patients with diplopia and small-angle hypertropia caused by mild to moderate inferior oblique overaction (IOOA) secondary to acquired superior oblique palsy (SOP). Methods Nine adult patients with diplopia and small-angle hypertropia associated with mild to moderate IOOA secondary to unilateral acquired SOP were included in the current retrospective study. All patients received the IOBT procedure between February 2019 and May 2023 at The Second People’s Hospital of Jinan and were followed up for more than 6 months after the surgery. During the procedure, the belly of the inferior oblique muscle was fixed to the sclera at 5 mm posterior to the temporal insertion of the inferior rectus muscle. The following indicators were reviewed pre- and post-surgery: the vertical deviation (VD) in the primary position and in the Bielschowsky test, the fovea disc angle (FDA) of the affected eye, changes in IOOA, and diplopia. Results After IOBT, the VD in the primary position decreased from 7.22 △  ± 1.72 △ (range 4 △ –10 △ ) to 1.22 △  ± 1.30 △ (range 0 △ –3 △ ). The VD in the Bielschowsky test decreased from 13.00 △  ± 1.80 △ to 3.22 △  ± 1.09 △ . The FDA decreased from 10.02° ± 3.34° to 6.26° ± 1.91°. The grade of IOOA was reduced from 2.00 (1.00, 2.00) to 0.00 (0.00, 1.00). All changes were statistically significant ( P  < 0.001 or P  = 0.006). Diplopia was resolved completely for all patients. Conclusions IOBT can effectively treat adults with diplopia and small-angle hypertropia caused by mild to moderate IOOA secondary to acquired SOP.

PurposeTo identify preoperative factors associated with the surgical corrective effect of contralateral inferior rectus recession (IRR) for vertical deviation in patients with congenital superior oblique palsy (SOP).MethodsThis retrospective study included 20 treatment-naïve patients with unilateral congenital SOP (age range, 6–79 years) who underwent contralateral IRR according to our basic policy to select IRR for paretic eye fixation. The corrective effect (°/mm) of IRR was defined as the difference in the vertical deviation at the primary gaze position between before and 6–18 months after surgery per distance of recession. We also measured the preoperative vertical deviation at primary and secondary gaze positions, and vertical deviation with head-tilting, and calculated the difference in vertical deviation between these positions. We analyzed the correlation between the corrective effect of IRR and these study parameters.ResultsThe mean corrective effect of IRR was 2.4 ± 1.6°/mm, which had a significant correlation with preoperative differences in vertical deviation between the primary gaze position and the downward (P = 0.004, r = −0.61) and contralateral gaze positions (P = 0.03, r = −0.48); and the presence of preoperative stereopsis (P = 0.02, r = −0.51). After excluding a statistical outlier, the correlation between the corrective effect and the difference between the primary and contralateral gaze positions was no longer significant (P = 0.07), while the other two relationships remained significant.ConclusionsOur findings suggest that preoperative differences in vertical deviation between the primary and downward gaze positions and the presence of preoperative stereopsis are important considerations prior to performing IRR for congenital SOP, particularly with paretic eye fixation.

The purpose of this study is to know clinical factors underlying either a single surgery or repetitive surgeries, required to treat superior oblique muscle palsy. Retrospective review was made on 246 consecutive patients with idiopathic (n = 212) or acquired (n = 34) superior oblique muscle palsy who underwent surgeries in 8 years at one institution. Idiopathic palsy included congenital and decompensated palsies while acquired palsy included traumatic and ischemic palsies. Clinical factors, compared between groups with a single surgery (n = 203) and two or more surgeries (n = 43), were surgical methods, sex, age at surgery, horizontal, vertical, and cyclotorsional deviations, and stereopsis at near fixation. Inferior oblique muscle recession on paretic side was chosen in about 60% of the single-surgery and repetitive-surgery group as an initial surgery, followed by inferior rectus muscle recession on non-paretic side. The age at surgery was significantly older, vertical and cyclotorsional deviations were significantly larger in the repetitive-surgery group, compared with the single-surgery group ( P = 0.01, P < 0.001, P = 0.02, Mann–Whitney U-test, respectively). The 95% confidence interval of vertical deviations was 15–17 prism diopters in the single-surgery group and 23–28 prism diopters in the repetitive surgery group. Significant differences in vertical deviations were replicated also in subgroups of patients with either idiopathic or acquired palsy. In conclusions, the 95% confidence interval of vertical deviations, determined by alternate prism and cover test, would be used as a common benchmark for predicting either a single surgery or repetitive surgeries, required to treat idiopathic and acquired superior oblique muscle palsy, in the process of obtaining the informed consent.

Background Although scleral search coils are widely and accurately used for the measurement of Listing’s plane in both eyes, they require specialized equipment and are invasive. In this study, we describe a convenient and less invasive method that uses a synoptometer to analyze the differences in orientation of Listing’s plane (difLP), and the effects of vertical muscle surgery on the difLP tilt in patients with superior oblique palsy (SOP). Methods Seventeen patients with unilateral congenital SOP (CSOP) and four patients with unilateral acquired SOP (ASOP) who had not undergone any strabismus surgeries were examined. Cyclodeviations of 13 vertical and horizontal gaze points within 30° were measured with a synoptometer, and the difLP tilts in the yaw and pitch planes were analyzed before and after vertical muscle surgery. Results The difLP tilt in the CSOP patients was significantly tilted nasally ( p  = 0.02) and forward on the lower side ( p  = 0.001), whereas that in ASOP patients tended to tilt temporally ( p  = 0.15). Ipsilateral inferior oblique recession (IOR) performed in seven CSOP patients tended to improve the difLP tilt in both the yaw ( p  = 0.07) and pitch ( p  = 0.09) planes, whereas contralateral inferior rectus recession (IRR) performed in three CSOP patients significantly improved the difLP tilt in the pitch plane ( p  = 0.015). The mean excyclodeviations in the 13 gaze points were significantly improved with both procedures ( p  < 0.0001 for both). Conclusions The difLP tilt in the SOP patients could be analyzed with a convenient and less invasive method using a synoptometer, and dissimilar difLP tilts were confirmed in the ASOP and CSOP patients. The results of this study suggest that both IOR and IRR are reasonable treatments for improving the difLP tilt in CSOP patients. IOR should be selected for patients with a steep preoperative difLP tilt to the nasal side, whereas IRR should be selected for patients with a gentle preoperative difLP tilt.