Transposición de los rectos verticales sin desinserción (TRVsD).Reduciendo el riesgo de isquemia del segmento anterior

  1. Lucía Perucho-González 1
  2. Alejandra Acebal-Montero 2
  3. Mauro Dupré-Peláez 1
  4. Laura Morales-Fernández 1
  5. Blanca de Domingo-Gordo 1
  6. Rosario Gómez de Liaño 1
  1. 1 Hospital Clínico San Carlos de Madrid
    info

    Hospital Clínico San Carlos de Madrid

    Madrid, España

    ROR https://ror.org/04d0ybj29

  2. 2 Instituto de Investigación Sanitaria del Hospital Clínico San Carlos
    info

    Instituto de Investigación Sanitaria del Hospital Clínico San Carlos

    Madrid, España

    ROR https://ror.org/014v12a39

Revue:
Acta estrabológica: publicación oficial de la Sociedad Española de Estrabología, Pleóptica, Ortóptica, Visión Binocular, Reeducación y Rehabilitación Visual

ISSN: 0210-4695,  1989-7278

Année de publication: 2017

Volumen: 46

Número: 1

Pages: 33-40

Type: Article

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D'autres publications dans: Acta estrabológica: publicación oficial de la Sociedad Española de Estrabología, Pleóptica, Ortóptica, Visión Binocular, Reeducación y Rehabilitación Visual

Résumé

Purpose: To report the results of Vertical Rectus Transposition without Disinsertion (VTRwD) based on the Nishida procedure with G. Marcon Modification for VI nerve palsy in three different types of oculomotor palsies in patients at risk of anterior segment ischemia. The variation of this technique consists in knotting the vertical muscles with a non absorbable suture, which is passed below the muscle belly of the horizontal rectus muscle (lateral rectus if esotropia and medial rectus if exotropia). Methods: Retrospective, interventional, case series in which three patients with different oculomotor palsies underwent this new muscle transposition procedure, in which a suture was first inserted through the margin of each vertical rectus muscle and then the same monofilament suture was Knotted below the muscle belly of the horizontal rectus muscles. Patient 1 had a combined III and abducens nerve palsies. Patient 2 had a III nerve palsy with multiple previous surgeries and patient 3 had a severe medial rectus damage secondary to a rabdomyosarcoma surgery and radiotherapy. The new described technique consist in that the vertical muscles are not sutured to the sclera, but simply are knotted below the muscle belly of the horizontal rectus muscle. Results: Patients 1 and 2 had excellent results. Patient 3 having a rabdomyosarcoma and very severe restrictions improved but the suture loosened and need further surgery. Anterior segment ischemia did not occur in any patients. Conclusions: This procedure, which achieved the same corrective results as other popular procedures, is simple to perform because it requires only a suture from the vertical muscles and a simple Knott below the belly of horizontal muscles. Tenotomy or splitting of the transposed muscles is unnecessary, neither suture onto the sclera. For these reasons this new technique is advantageous in patients at risk of anterior segment ischemia.

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