Wydanie 1/2010

Porażenie nerwu VI - leczenie metodą transpozycji mięśni prostych pionowych

Sixth Nerve Palsy - Treatment with Vertical Rectus Muscles Transposition

Olimpia Nowakowska, Piotr Loba, Anna Broniarczyk-Loba

Zakład Patofizjologii Widzenia Obuocznego i Leczenia Zeza I Katedry Chorób Oczu Uniwersytetu Medycznego w Łodzi Kierownik: prof. dr hab. n. med. Anna Broniarczyk-Loba Klinika Chorób Oczu I Katedry Chorób Oczu Uniwersytetu Medycznego w Łodzi Kierownik: prof. dr hab. n. med. Wojciech Omulecki

Summary: Aim: Patients with VIth nerve palsy, which does not resolve within 6 months should undergo surgery. The aim of our study was to evaluate the results of vertical rectal muscles transposition performed in patients with abducens nerve palsy that were referred to the Ophthalmology Department and Department of Binocular Vision Pathophysiology and Strabismus, Medical University of Lodz. Patients and Methods: Ten cases of abducens nerve palsy ware retrospectively analyzed. All patients underwent full ophthalmic and orthoptic examination before and after the surgery, with special regard to proper alignment and diplopia resolution in primary position, broadening of the field of binocular single vision and abduction enhancement. Nine patients underwent transposition of the temporal halves of vertical rectus muscles to the lateral rectus insertion with its resection. In 1 case the Jensen?s procedure was performed. In some cases additional procedures were necessary. Results: Before the surgery the abduction was absent in all cases. After the surgery we have found abduction improvement up to -35° with mean of -18°. Mean area of diplopia was 91.2% preoperatively and 21.1% postoperatively in the binocular single vision (BSV) examination. There was no diplopia in primary position. One patient needed a prism correction. There was a significant reduction in the strabismus angle for distance (mean 66.9?) and near (mean 65.3?). This allowed a horizontal angle to reach mean +5.1? for distance and +2.4? for near. Conclusion: The vertical rectus muscles transposition technique allows to achieve orthoforia, improvement of abduction and larger field of binocular single vision in patients with abducens nerve palsy.

Słowa kluczowe: porażenie n. VI, leczenie chirurgiczne zeza, transpozycja mięśni prostych pionowych.

Keywords: sixth nerve palsy, surgical treatment of strabismus, vertical rectus muscles transposition.


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