The Use of Titanium T-Plate as Platform for Globe Alignment in Severe Paralytic and Restrictive Strabismus

Purpose To evaluate the long-term effectiveness of improved ocular alignment using a suture/T-plate anchoring platform system. Design Retrospective, noncomparative, interventional case series. Methods setting: Institutional. study population: Seven consecutive patients with large angle deviations at...

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Bibliographic Details
Published in:American journal of ophthalmology 2010-09, Vol.150 (3), p.404-411.e1
Main Authors: Tse, David T, Shriver, Erin M, Krantz, Kenneth B, Tse, Jeffrey D, Capo, Hilda, McKeown, Craig A
Format: Article
Language:English
Subjects:
Adult
Aged
Biological and medical sciences
Colleges & universities
Diplopia - physiopathology
Dissection
Expert witness testimony
Female
Humans
Male
Medical sciences
Middle Aged
Miscellaneous
Oculomotor Muscles - surgery
Ophthalmologic Surgical Procedures - instrumentation
Ophthalmology
Polyethylene terephthalate
Retrospective Studies
Strabismus - physiopathology
Strabismus - surgery
Surgery
Surgical techniques
Suture Techniques
Titanium
Treatment Outcome
Vision, Binocular - physiology
Young Adult
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Summary:Purpose To evaluate the long-term effectiveness of improved ocular alignment using a suture/T-plate anchoring platform system. Design Retrospective, noncomparative, interventional case series. Methods setting: Institutional. study population: Seven consecutive patients with large angle deviations attributable to paralytic and/or restrictive strabismus managed jointly by orbital and strabismus surgeons. intervention procedure: The T-plate base is anchored to the orbital rim with the shaft projecting toward the orbital apex to simulate the origin of the affected muscle. A nonabsorbable suture serves as the coupling element linking the muscle insertion to the tip of the T-plate such that the suture coincides with the axis of the dysfunctional muscle and yields a pull vector to simulate the passive tensile force of the muscle. Information analyzed included patient demographics, etiology of strabismus and characteristics, prior muscle surgeries, secondary interventions, subjective appraisal of diplopia, and final ocular alignment measurements. main outcome measures: Subjective appraisal of diplopia, final ocular alignment in primary gaze, and late stability. Results All 7 patients showed marked reduction in ocular deviation with a median change of 33 prism diopters (PD) and a range of 7 to 72 PD. For the 6 patients with medial rectus dysfunction, the final ocular alignment ranged from 6 to 18 PD of residual exotropia in primary gaze. The patient with sixth nerve palsy had 5 PD of residual esotropia. There were no failures after an average of 59.4 months of follow-up. Conclusions A globe tethering technique using a suture/titanium T-plate anchoring platform system effectively treats refractory cases of paralytic and restrictive strabismus with large angles of deviation.
ISSN:0002-9394
1879-1891
DOI:10.1016/j.ajo.2010.03.029