Sharma Pradeep, Chaurasia Shweta, Rasal Abhijit
Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
BMJ Case Rep. 2017 Aug 9;2017:bcr-2017-220404. doi: 10.1136/bcr-2017-220404.
A 16-year-old girl presented with left eye large-angle exotropia. On examination, we found bilateral limitation of adduction. CT orbit showed hypoplastic medial rectus bilaterally, but intraoperatively we found absent medial recti on both sides. This case report explains discrepancy between the imaging and the intraoperative findings and discusses the management dilemma in view of the risk of anterior segment ischaemia and how marked exodeviation and adduction limitation was tackled by the new technique of transposition myopexy, a modification of the procedure described by Nishida along with recession of lateral rectus to achieve good alignment. This procedure changes the vector forces of the vertical rectus without splitting or tenotomy of the muscles.
一名16岁女孩因左眼大角度外斜视就诊。检查时，我们发现双眼内收受限。眼眶CT显示双侧内直肌发育不全，但术中发现双侧内直肌缺如。本病例报告解释了影像学检查结果与术中所见之间的差异，并鉴于前段缺血风险讨论了治疗困境，以及如何通过转位固定术新技术（一种对Nishida所描述手术的改良方法）来处理明显的外斜视和内收受限，同时外直肌后徙以实现良好的眼位矫正。该手术改变了垂直肌的矢量力，而无需对肌肉进行劈开或切断。
