Abstract
Purpose
To investigate the extent of adhesion and changes in the Y configuration after the Y-split procedure, compared with the posterior fixation suture.
Methods
Twelve New Zealand white rabbits were included in the study. The 10-mm Y-split procedure was performed in the superior rectus muscle (SR) of one eye, and the 10-mm posterior fixation suture was made in the SR of the other eye. Six weeks after surgery, the Y arm lengths and lengths of adherence to the sclera were measured. If the adhesion involved the whole Y arm, the distance between the original SR insertion and most proximal part of the adhered SR was measured. In the eyes with posterior fixation suture, the distance between the SR insertion and most proximal part of the adhered SR was evaluated.
Results
The average nasal and temporal Y arm lengths were 6.37 ± 0.65 and 6.54 ± 0.63 mm, respectively, a significant decrease from those measured immediately after surgery (P = 0.002 and 0.002, respectively). Adhesions involved the entire Y arms in 11 of 12 SRs (91.7%), with an average adhesion length of 7.01 ± 1.04 mm. In SRs with posterior fixation sutures, the average adhesion was 9.18 ± 0.62 mm from the insertion, which was only 2.17 mm posterior to proximal portion of adhesion in Y-split SR (P < 0.001).
Conclusions
Healing process reduces the Y arm length. Adhesion may involve the entire Y arm and could weaken or alter the therapeutic mechanism after the Y-split procedure.
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References
Oystreck DT, Engle EC, Bosley TM (2011) Recent progress in understanding congenital cranial dysinnervation disorders. J Neuroophthalmol 31:69–77. https://doi.org/10.1097/WNO.0b013e31820d0756
von Noorden GK, CE (2002) Binocular vision and ocular motility, 6th edn. Mosby, St. Louis
Rogers GL, Bremer DL (1984) Surgical treatment of the upshoot and downshoot in Duanes' retraction syndrome. Ophthalmology 91:1380–1383
Sukhija J, Kaur S (2013) Isolated Y splitting and recession of the lateral rectus muscle in patients with exo-Duane syndrome. Strabismus 21:1–2. https://doi.org/10.3109/09273972.2012.762534
Sprunger DT (1997) Recession of both horizontal rectus muscles in Duane syndrome with globe retraction in primary position. J AAPOS 1:31–33
Mohan K, Saroha V (2002) Vertical rectus recession for the innervational upshoot and downshoot in Duane's retraction syndrome. J Pediatr Ophthalmol Strabismus 39:94–99
Awadein A (2013) Inferior oblique myectomy for upshoots mimicking inferior oblique overaction in Duane retraction syndrome. J AAPOS 17:253–258. https://doi.org/10.1016/j.jaapos.2013.01.005
Farid MF (2016) Y-split recession vs isolated recession of the lateral rectus muscle in the treatment of vertical shooting in exotropic Duane retraction syndrome. Eur J Ophthalmol 26:523–528. https://doi.org/10.5301/ejo.5000746
Kekunnaya R, Kraft S, Rao VB, Velez FG, Sachdeva V, Hunter DG (2015) Surgical management of strabismus in Duane retraction syndrome. J AAPOS 19:63–69. https://doi.org/10.1016/j.jaapos.2014.10.019
Rao VB, Helveston EM, Sahare P (2003) Treatment of upshoot and downshoot in Duane syndrome by recession and Y-splitting of the lateral rectus muscle. J AAPOS 7:389–395. https://doi.org/10.1016/S1091853103002131
Velez FG, Velez G, Hendler K, Pineles SL (2012) Isolated y-splitting and recession of the lateral rectus muscle in patients with exo-duane syndrome. Strabismus 20:109–114. https://doi.org/10.3109/09273972.2012.702323
Scott AB (1977) The faden operation: mechanical effects. Am Orthopt J 27:44–47
Ahn SE, Han JY, Kim SH, Cho YA, Suh YW (2014) Stability of Y-splitting procedure combined with hang-back recession of the rectus muscle in rabbit eyes. Graefes Arch Clin Exp Ophthalmol 252:59–62. https://doi.org/10.1007/s00417-013-2511-4
Takeuchi K, Nakazawa M, Metoki T, Yamazaki H, Miyagawa Y, Ito T (2011) Effects of solid hyaluronic acid film on postoperative fibrous scar formation after strabismus surgery in animals. J Pediatr Ophthalmol Strabismus 48:301–304. https://doi.org/10.3928/01913913-20100920-02
Akar S, Gokyigit B, Aygit ED, Sabanci S, Demirok A (2013) Is y-split recession of the medial rectus muscle as effective as scleral retroequatorial myopexy of the medial rectus muscle for partially accommodative esotropia with convertgence? A report of results in 61 cases. Binocul Vis Strabolog Q Simms Romano 28:167–175
Wipf M, Priglinger S, Palmowski-Wolfe A (2017) Y-Split recession of the medial rectus muscle as a secondary and/or unilateral procedure in the treatment of esotropia with distance/near disparity. J Ophthalmol 2017:6472690. https://doi.org/10.1155/2017/6472690
Hoerantner R, Priglinger S, Koch M, Haslwanter T (2007) A comparison of two different techniques for oculomotor torque reduction. Acta Ophthalmol Scand 85:734–738. https://doi.org/10.1111/j.1600-0420.2007.00933.x
Hoerantner R, Priglinger S, Haslwanter T (2004) Reduction of ocular muscle torque by splitting of the rectus muscle II: technique and results. Br J Ophthalmol 88:1409–1413. https://doi.org/10.1136/bjo.2004.042721
Haslwanter T, Hoerantner R, Priglinger S (2004) Reduction of ocular muscle power by splitting of the rectus muscle I: biomechanics. Br J Ophthalmol 88:1403–1408. https://doi.org/10.1136/bjo.2004.042713
Suh YW, Park JH, Cho YA (2011) The effect of botulinum toxin injection on the hang-back recession of rectus muscles. Graefes Arch Clin Exp Ophthalmol 249:921–924. https://doi.org/10.1007/s00417-011-1615-y
Ryu WY, Bae JB (2013) Changes in sagging extraocular muscle following surgical recession of the superior rectus muscle in rabbit eyes. J Pediatr Ophthalmol Strabismus 50:162–168. https://doi.org/10.3928/01913913-20130129-02
Chang M, Kim JH, Kim SH (2011) The change of the extraocular muscle insertion after a slanted recession in rabbit eyes. Graefes Arch Clin Exp Ophthalmol 249:1373–1377. https://doi.org/10.1007/s00417-011-1647-3
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This study was funded by a grant from Korea University (K1422451).
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Choi, Y., Jang, S., Choi, S.Y. et al. Adhesion after Y-split procedure can affect its mechanism for treating overshoots in Duane’s syndrome. Graefes Arch Clin Exp Ophthalmol 257, 391–395 (2019). https://doi.org/10.1007/s00417-018-4181-8
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DOI: https://doi.org/10.1007/s00417-018-4181-8