Godeiro Katyanne Dantas, Pinto Anderson Gustavo Teixeira, Souza Filho Joao Pessoa, Petrilli Ana Maria Noriega, Nakanami Celia Regina
Henry C. Witelson Ocular Pathology Laboratory, Department of Ophthalmology, McGill University, Lyman Duff Building, 3775 University Street, Room 216, Montreal, QC, Canada, H3A 2B4.
Int Ophthalmol. 2005 Aug-Oct;26(4-5):185-9. doi: 10.1007/s10792-007-9035-z. Epub 2007 Feb 8.
To report a case of traumatic tear of the inferior rectus muscle treated with inferior oblique anterior transposition (IOAT).
Case report of a 55-year-old man who presented with vertical diplopia (VD) after orbital trauma. Ocular examination disclosed a 62PD right hypertropia (RHT) in the primary position (PPO). The right inferior rectus (RIR) was torn, and the distal stump was fixed to the skin with tape.
Surgery was performed under local anesthesia. The RIR tearing occurred 13 mm from the insertion, and exploration revealed its proximal end. The right inferior oblique (RIO) was intact, although its fibers were loose. Since the RHT did not improve following reattachment of the proximal and distal stumps of the RIR, the distal stump was excised and the proximal end brought forward and sutured 6.5 mm from the limbus. At perioperative evaluation, there was a 25PD RHT in PPO where the VD persisted. The RIO was subsequently isolated, detached, and its distal end, after 6 mm resection, was sutured to a point temporal to the lateral border of the RIR. The patient was reevaluated and had neither RHT nor VD in primary gaze. At the 6-week postoperative evaluation, he was orthotropic in PPO, complaining about diplopia only on extreme downgaze. A mild limitation of right depression was observed. The patient was satisfied with the surgical results and experienced no functional limitations during any activities.
IOAT can provide acceptable binocular visual function without the risk of anterior segment ischemia in cases of torn inferior rectus muscle.
报告1例采用下斜肌前转位术（IOAT）治疗的下直肌外伤性撕裂病例。
病例报告，一名55岁男性，眼眶外伤后出现垂直性复视（VD）。眼部检查发现，第一眼位（PPO）时右眼上斜视（RHT）为62棱镜度（PD）。右下直肌（RIR）撕裂，其远端残端用胶带固定于皮肤。
在局部麻醉下进行手术。RIR撕裂部位距附着点13 mm，探查发现其近端。右下斜肌（RIO）完整，但其纤维松弛。由于RIR近端和远端残端重新附着后RHT未改善，故切除远端残端，将近端向前牵拉并缝合于角膜缘6.5 mm处。围手术期评估时，第一眼位仍存在25 PD的RHT，VD持续存在。随后分离、切断RIO，切除其远端6 mm后，将其缝合于RIR外侧缘颞侧的一点。再次评估时，患者第一眼位既无RHT也无VD。术后6周评估时：他在第一眼位眼位正常，仅在极度下视时抱怨有复视。观察到右眼轻度下转受限。患者对手术结果满意，在任何活动中均未出现功能受限。
对于下直肌撕裂的病例，IOAT可提供可接受的双眼视觉功能，且无前节缺血风险。
