Periosteal Fixation in Bilateral Total Third Nerve Palsy. |
Kyung Won Suk, Jung Min Park, Sang Soo Kim, Soo Jung Lee |
Department of Ophthalmology, Maryknoll Hospital, Pusan, Korea. kris9352@hanmail.net |
양안 완전 동안신경마비에서 골막 고정술을 이용한 외편위 교정 1예 |
석경원ㆍ박정민ㆍ김상수ㆍ이수정 |
Department of Ophthalmology, Maryknoll Hospital, Pusan, Korea |
Correspondence:
Kyung-Won Suk, M.D. |
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Abstract |
PURPOSE We present a new technique of anchoring the eyeball to the nasal periosteum with supramaximal recession of the lateral rectus muscle in one eye for exotropia management in bilateral total third nerve palsy combined with trochlear nerve palsy. CASE SUMMARY: A 38-year-old man presented with drooping of both upper lids and exodeviation of the left eye with a history of intraventricular hemorrhage 9 months previously. We noted bilateral ptosis, dilated pupils, right fixing eye, left face turn, and left exotropia over 100 prism diopters (PD) in the primary position with an inability to move both eyes together except abduction. He was diagnosed with bilateral total third nerve palsy and trochlear nerve palsy. We fixated the left globe (sclera anterior to the insertion of the medial rectus muscle) to the nasal periosteum including the medial palpebral ligament using a nonabsorbable suture. A large recession of the left lateral rectus muscle (14 mm) was also performed. Ocular alignment in the primary position was exotropia of 25PD and cosmetically satisfactory after 6 months of follow-up. CONCLUSION: Supramaximal recession of the lateral rectus muscle and periosteal fixation using nonabsorbable suture is an effective technique for the management of exotropia secondary to total third nerve palsy. |
Key Words:
Exotropia;Nonabsorbable suture;Periosteal fixation;Supramaximal recession;Total third nerve palsy |
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