Download rajiv gandhi university of health sciences, bangalore, karnataka

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE,
KARNATAKA
ANNEXURE – II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1
NAME OF THE CANDIDATE &
DR. SHWETHA H.R.
ADDRESS
NO.749, 4 TH BLOCK, 8TH MAIN,
(IN BLOCK LETTERS)
9TH CROSS, B.E.L. LAYOUT,
VIDYARANYAPURA
BANGALORE – 560097.
2
NAME OF THE INSTITUTION
MINTO OPHTHALMIC HOSPITAL,
BANGALORE MEDICAL COLLEGE
AND RESEARCH INSTITUTE,
BANGALORE.
3
COURSE OF THE STUDY AND
SUBJECT
M.S. IN OPHTHALMOLOGY
4.
DATE OF ADMISSION TO COURSE
15TH APRIL, 2009
5.
TITLE OF THE TOPIC
‘RESULTS OF EXTRAOCULAR
MUSCLE TRANSPOSITIONS IN
VARIOUS TYPES OF
STRABISMUS’
6.
BRIEF RESUME OF THE INTENDED WORK
6.1
NEED FOR STUDY
Muscle Transpositions are done in cases in which function of the muscle cannot be
improved by any strengthening procedure. The adjacent muscles can be transposed
to aid the action of paralytic muscle 1. There is no universal consensus on the type
of surgery to be done for a particular type of strabismus. Hence the study to
understand the results of muscle transpositions.
6.2
REVIEW OF LITERATURE
Muscle Transposition is a technique of reinsertion of adjacent muscles close to the
paralysed muscle to strengthen its action. It is indicated in oculomotor nerve palsy,
lateral rectus muscle palsy, monocular elevator deficiency, monocular depressor
palsy, alphabet pattern strabismus, and rarely in duane retraction syndrome.
Types :

Peter’s procedure: Indicated for oculomotor nerve palsy.
Here, superior
oblique tendon is shortened and reattached to sclera near insertion of medial
rectus muscle 2.

Hummelshiem’s procedure: Indicated for Lateral rectus palsy or lost muscle.
Here, lateral halves of superior and inferior recti are dissected upto 14mm
from their insertion and re-inserted adjacent to lateral rectus muscle
insertion 3 .

Jensen’s procedure: Indicated for lateral rectus muscle palsy. Here, lateral
halves of superior and inferior rectus muscle and upper and lower halves of
lateral rectus muscle are dissected for about 14mm from their insertion and
lateral half of superior rectus muscle and upper half of lateral rectus muscle
tied with mersilene suture.
This procedure has lesser chance of anterior
segment ischemia 4.

Callahan’s procedure: Indicated for elevator deficiency. Here upper half of
medial and lateral rectus muscle are sutured with the two halves of superior
rectus muscle.

O’Connor’s procedure: Here, vertical recti are transposed to lateral recti.

Knapp’s procedure: Indicated in double elevator or depressor palsy. Here,
horizontal recti are transposed to superior rectus muscle.
STUDIES :

Paysee EA, Saunders RA, Coats DK did a study on surgical management of
strabismus after rupture of the inferior rectus muscle and showed that the
modified Jenson’s transposition of the horizontal rectus muscles appears to
be highly effective in the treatment of hypertropia and infraduction deficit
produced by rupture of inferior rectus muscle 5.

Young TL, Conahan BM, Summers CG, Egbert JE. did a study on anterior
transposition of superior oblique tendon in the treatment of oculomotor nerve
palsy and its influence on post operative hypertropia 6 .

Goldchmit M, Felberg S, Souza-Dias C did a study on unilateral anterior
transposition of the inferior oblique muscle for correction of hypertropia in
primary position and showed that it is an effective technique for correction
of large hypertropia associated with marked unilateral inferior oblique
overaction 7.

Hong S, Chang YH, Lee JB did a study on the effect of full tendon
transposition augmented with posterior intermuscular suture for paralytic
strabismus and showed that it is an effective procedure that results in
improved ocular alignment in patients with paralytic strabismus 8.

Britt MT, Velez FG, Thacker N, Alcorn D, Foster RS, Rosenbaum AL did a
study on surgical management of globe retraction and pseudoptosis in Duane
retraction syndrome and showed that partial transposition of vertical rectus
muscles may improve the angle of esotropia in primary position and
abduction 9.
6.3
OBJECTIVES OF STUDY :
To study the results of extraocular muscle transposition in various types of
strabismus.
7.
MATERIALS AND METHODS
7.1
SOURCE OF DATA
Patients attending squint clinic and OPD at MINTO OPHTHALMIC HOSPITAL,
BMCRI, Bangalore presenting with various types of strabismus.
7.2
METHOD OF COLLECTION OF DATA
It is a hospital based prospective, Non-comparative; period of study, 1 year
interventional study of 20 patients undergoing muscle transposition surgeries in
different types of strabismus.
A detailed ophthalmic and orthoptic eval uation
includes visual acuity, Refraction testing, Fundus examination, Prism cover test to
measure the angle of deviation, Clinical photography and wherever indicated,
Forced duction test will be performed. Informed consent will be taken prior to the
surgical procedure after complete description of the procedure and its purpose to the
patients. The type of surgery for the individual cases will be based on what is
recommended in literature for such cases or some modification based on our
experience and discretion.
Post operatively patients will be followed up for a period of 1-2 months with a
detailed ophthalmic and orthoptic evaluation done during their each visit as in
preoperative evaluation. The amount of deviation is documented with photographs.
The result of surgery in terms of improving ocular alignment and motility will be
analysed.
INCLUSION CRITERIA :
a)
b)
c)
d)
e)
f)
g)
h)
Oculomotor nerve palsy
Superior oblique muscle palsy
Lateral rectus muscle palsy
Monocular double elevator deficiency
Monocular depressor palsy
Traumatic rupture or loss of rectus muscle
Duane Retraction syndrome
Any other type of strabismus which may be helped by muscle transposition.
EXCLUSION CRITERIA :
a) Cases in which surgery is contraindicated.
b) Cases in which patients have no realistic expectations.
7.3
DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR
INTERVENTIONS TO BE CONDUCTED ON PATIENT,
HUMAN OR ANIMAL?
Yes, in addition to visual acuity, Prism cover tests, surgical procedure and follow up
are required.
7.4
HAS ETHICAL CLEARANCE BEEN OBTAINED FROM
YOUR INSTITUTION IN CASE OF 7.3?
Yes.
8
LIST OF REFERENCES :
1.
Sharma P. “strabismus simplified”. 1st ed. Sahibabad: 1991. P 190
2.
Roperhall M.J. “stallard’s eye surgery”. 7th ed. Bombay: 1989. P 168.
3.
Krachmer J.H. “atlas of ophthalmic surgery techniques complication”. Vol I.
New Delhi: 1990. P 4.24.
4.
The Requisites. “pediatric ophthalmology and strabismus”. Mosby; 1999.
P.165-7.
5.
Paysse EA, Saunders RA, Coats DK. Surgical management of strabismus
after rupture of the inferior rectus muscle. American association of
Pediatric ophthalmology and strabismus 2000; 4(3): 164-7.
6.
Young TL, Conahan BM, Summers CG, Egbert JE. Anterior transposition of
superior oblique tendon in the treatment of oculomotor nerve palsy and
its influence on post operative hypertropia. Journal of pediatric
Ophthalmology and strabismus 2000; 37(3): 149-55.
7.
Goldchmit M, Felberg S, Souza-Dias C. Unilateral anterior transposition of
the inferior oblique muscle for correction of hypertropia in primary
position. American association of pediatric ophthalmology 2005;
140(3): 477-83.
8.
Hong S, Chang YH, Han SH, Lee JB. Effect of full tendon transposition
augmented with posterior intermuscular suture for paralytic
strabismus. American Journal of ophthalmology 2005; 140(3): 47783.
9.
Britt MT, Velez FG, et al. Surgical management of severe cocontraction,
globe retraction, and pseudo-ptosis in Duane syndrome. American
association of pediatric ophthalmology and strabismus 2004; 8(4):
361-7.
9.
SIGNATURE OF THE CANDIDATE :
10.
REMARKS OF THE GUIDE :
Muscle Transposition surgeries are reported for various types of strabismus.
Though they are useful, further improvements are necessary to enhance the quality
of results. A systematic study of these procedures will enhance our knowledge pool
and help us in giving better results.
11.
NAME AND DESIGNATION OF GUIDE :
DR. T.K. RAMESH
MBBS, MS(OPH), DNB, FRCS.
PROFESSOR
DEPARTMENT OF OPHTHALMOLOGY
MINTO OPHTHALMIC HOSPITAL
BANGALORE MEDICAL COLLEGE AND RESEARCH INSTITUTE,
BANGALORE – 560001.
11.1 SIGNATURE OF THE GUIDE :
11.2 CO-GUIDE (IF ANY) : NONE
11.3 SIGNATURE OF CO-GUIDE:
11.4 NAME AND DESIGNATION OF HOD :
DR. K.S. SRIPRAKASH
MBBS, M.S.(OPH)
MEDICAL SUPERINTENDENT
PROFESSOR AND HOD
DEPARTMENT OF OPHTHALMOLOGY
MINTO OPHTHALMIC HOSPITAL
BANGALORE MEDICAL COLLEGE AND RESEARCH INSTITUTE,
BANGALORE – 560001.
11.5 SIGNATURE OF HOD:
12.1 REMARKS OF CHAIRMAN AND PRINCIPAL :
12.2 SIGNATURE OF PRINCIPAL :