Eye Muscle Surgery: Basic Data

A. Roth, C. Speeg-Schatz

• Publisher: CRC Press
• Year: 2026
• eBook ISBN: 9781040893784
• Topic: Technology & Engineering
• Subtopic: Surgery & Surgical Medicine
• Index: Technology & Engineering

The aim of eye muscle surgery is to restore alignment of the visual axes and ocular stability. Albeit compensatory and largely empirical, this surgery can be perfected with a better understanding of the physiopathological mechanisms involved, more detailed semiological analysis, the taking into account of intraoperative data and the use of microsurgical technique. The three parts of this book allow each of these factors to be discussed at length.

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Authors and Contributors
• Preface to the English edition
• Foreword
• Notice
• Table of Contents
• Introduction
• Terminology
• PART ONE: BASIC DATA IN EYE MUSCLE SURGERY
• Chapter 1: Modeling and dynamics of the oculomotor complex
• 1. OCULAR MOVEMENTS
• 1.1. Constitutional asymmetry of the medial rectus and lateral rectus muscle pair
• 1.2. Reciprocal oculomotor balance
• 1.3. Conjugate ocular movements
• 2. ACTIONS OF THE EXTRAOCULAR MUSCLES
• 2.1. Definitions of movements
• 2.2. Action of individual muscles
• 2.3. Combined muscle actions
• 3. FORCES AT WORK: A TRIAL MODEL
• 3.1. Restrictive forces and effective forces
• 3.2. Evaluation of passive and active forces
• 3.3. Modeling of the oculomotor system
• Chapter 2: Effects of surgery
• 1. EFFECTS ACCORDING TO THE SURGICAL PROCEDURE
• 1.1. Muscle parameters and effect of surgery
• 1.2. Effects according to the surgical procedure
• 2. EFFECTS OF SURGERY ACCORDING TO THE CHOICE OF MUSCLE
• 2.1. Single-muscle surgery
• 2.2. Two-muscle surgery
• 3. UNDESIRABLE IATROGENIC EFFECTS OF MUSCLE SURGERY
• 3.1. Inevitable undesirable iatrogenic effects
• 3.2. Undesirable iatrogenic effects to be avoided
• Chapter 3: Evaluation of the extraocular muscle disorder
• 1. CLINICAL EVALUATION: FIRST DECISION-MAKING STAGE
• 2. RECORDING EXTRAOCULAR MUSCLE KINESIS: KINETIC ELECTRO-OCULO-GRAPHY (KEOG) AND PHOTO-OCULOGRAPHY (POG)
• 2.1. Technical considerations
• 2.2. Kinetic electro-oculography abnormalities
• 3. IMAGING: ECHOGRAPHY, SCANNING AND MAGNETIC RESONANCE
• 3.1. Echography
• 3.2. Computed tomography (CT)
• 3.3. Magnetic resonance imaging (MRI)
• 4. INTRA-OPERATIVE DATA: SECOND AND THIRD DECISION-MAKING STAGES
• 4.1. Eye position under anaesthesia
• 4.2. The muscle stretch test (MST)
• 4.3. Clinical method of collecting intra-operative data
• Chapter 4: Amount of surgery
• 1. AMOUNT OF CONVENTIONAL SURGERY ON THE RECTUS MUSCLES
• 1.1. Measuring the amount of surgery after mean surgical effectiveness
• 1.2. Calculating the amount of surgery from formulae
• 1.3. Effect on the angle of deviation according to the surgical distribution
• 1.4. Validity and limits of methods of calculation
• 2. AMOUNT OF SURGERY ON THE OBLIQUE MUSCLES
• 2.1. Amount of surgery by estimation
• 2.2. Amount of surgery by calculation
• 3. LIMITS FOR CONVENTIONAL MUSCLE SURGERY
• 3.1. Usual acceptable limits
• 3.2. Small and large amounts of surgery
• 4. DISTANCE OF POSTERIOR ANCHORAGE
• 4.1. Distance according to the muscle to be operated
• 4.2. Amount of muscle recession to be associated
• 5. ADJUSTMENT OF THE AMOUNT OF SURGERY
• 5.1. Factors to take into consideration: dimensions of the eye
• 5.2. Factors to take into consideration: intra-operative data
• Chapter 5: Psychological context of strabismus surgery
• 1. PARENTAL REACTION TO STRABISMUS
• 2. EMOTIONAL REACTIONS OF THE STRABISMIC CHILD
• 3. EMOTIONAL ASPECTS OF HOSPITALIZATION OF CHILDREN FOR STRABISMUS SURGERY
• 4. PREVENTIVE STRATEGY
• 5. REACTION OF THE CHILD AND PARENTS ON THE DAY AFTER SURGERY PART TWO: OPERATIVE TECHNIQUES
• Chapter 6: Anaesthesia
• 1. CHOICE OF ANAESTHESIA
• 2. GENERAL ANAESTHESIA
• 2.1. Aspects of manipulation and complications
• 2.2. Preparation for surgery
• 2.3. Anaesthetic protocol
• 3. LOCAL ANAESTHESIA
• 4. TOPICAL ANAESTHESIA
• Chapter 7: Surgical equipment
• 1. MAGNIFYING SYSTEMS
• 1.1. Surgical microscopes
• 1.2. Operating spectacles (loupe magnification)
• 1.3. Which system to choose?
• 2. INSTRUMENTS ADAPTED FOR EYE-MUSCLE MICROSURGERY
• 2.1. Eye specula
• 2.2. Forceps
• 2.3. Scissors
• 2.4. Muscle hooks
• 2.5. Myometer
• 2.6. Muscle clamp
• 2.7. Retractors
• 2.8. Calipers and markers
• 2.9. Needle-holders
• 2.10. Sponge-swabs
• 2.11. Cautery and electric scalpel
• 3. SUTURE MATERIALS
• 3.1. Needles
• 3.2. Suture thread
• 3.3. Tissue adhesives (Tissue glue)
• 3.4. Implants of absorbable or nonabsorbable materials
• Chapter 8: Preparation for surgery.
• 1. PREPARATION OF THE PATIENT
• 2. PREPARATION OF THE OPERATING FIELD
• 3. PREPARATION OF THE SURGICAL TEAM
• Chapter 9: Access to the extraocular muscles: incision, muscle dissection, and sutures.
• 1. REQUIREMENTS TO BE MET BY THE ACCESS ZONE
• 2. SURGICAL ANATOMY OF THE ACCESS ZONE
• 2.1. Tenon’s capsule and the sclera
• 2.2. Tenon’s capsule and the rectus muscles
• 2.3. Tenon’s capsule and the oblique muscles
• 3. ACCESS TO THE RECTUS MUSCLES
• 3.1. Limbus incision
• 3.2. Two-plane peripheral incision
• 3.3. Recession of Tenon’s capsule
• 4. ACCESS TO THE OBLIQUE MUSCLES
• 4.1. Incision
• 4.2. Access to the inferior oblique
• 4.3. Access to the superior oblique
• 4.4. Suturing
• 5. USE OF ABSORBABLE FOILS
• 6. POST-OPERATIVE ROUTINE
• 6.1. After the surgical procedure
• 6.2. The day after surgery and immediate follow-up
• 6.3. Long-term follow-up
• Chapter 10: Rectus muscle surgery.
• 1. SURGICAL ANATOMY OF THE RECTUS MUSCLES
• 2. MUSCLE WEAKENING TECHNIQUES
• 2.1. Muscle recession with scleral reattachment (Jameson procedure)
• 2.2. Muscle recession with a loop or controlled tenotomy
• 2.3. Muscle and Tenon’s capsule recession
• 2.4. Other muscle weakening techniques 3. MUSCLE STRENGTHENING TECHNIQUES
• 3.1. Muscle plication
• 3.2. Muscle resection
• 3.3. Muscle resection with advancement
• 3.4. Other muscle strengthening techniques
• 4. ADJUSTABLE SURGERY: ADJUSTABLE SUTURES
• 4.1. Adjustable recession
• 4.2. Adjustable resection or plication
• 4.3. Adjustment
• 4.4. The conjunctiva in adjustable surgery
• 4.5. The role of adjustable surgery
• 5. SHIFTING OF MUSCLE INSERTIONS AND "SLANTED" WEAKENING OR STRENGTHENING PROCEDURES
• 5.1. Vertical shifting of horizontal recti to correct hyper or hypotropia
• 5.2. Vertical shifting of horizontal recti to correct A and V patterns (Costenbader-Knapp procedure, 1959)
• 5.3. Horizontal shifting of vertical recti to correct A and V patterns (Procedure according to Fink, 1959, Miller, 1960)
• 5.4. "Slanted" weakening or strengthening procedures to correct A and V patterns
• 6. THE SO-CALLED "FADENOPERATION" OR POSTERIOR ANCHORAGE PROCEDURE 189
• 6.1. Synonymy
• 6.2. Posterior anchorage techniques
• 6.3. Posterior anchorage: features depending on which muscle is operated
• 6.4. Posterior anchorage combined with conventional surgery
• 6.5. Comments on posterior anchorage
• 6.6. Incidents with and complications of posterior anchorage
• 6.7. Contraindications for posterior anchorage
• 7. SUBSTITUTION TECHNIQUES
• 7.1. Part-muscle transposition techniques
• 7.2. Whole-muscle transposition techniques
• 7.3. Jensen’s procedure
• 7.4. Single muscle transposition
• 7.5. Transposition of two neighbouring recti muscles: Kaufmann’s strap operation
• 8. SUPPLEMENTARY TECHNIQUES
• 8.1. Elastopexy
• 8.2. Very large recessions and resections
• 8.3. Traction sutures (Anchoring sutures)
• 8.4. Interposition of absorbable or nonabsorbable materials
• 9. INTRAMUSCULAR INJECTION OF BOTULINUM TOXIN (TECHNICAL ASPECTS) . . . 210
• 9.1. Preparation of botulinum toxin A
• 9.2. Intramuscular injection technique
• 9.3. Side effects and complications
• Chapter 11: Oblique muscle surgery
• 1. SURGICAL ANATOMY OF THE OBLIQUE MUSCLES
• 1.1. The superior oblique
• 1.2. The inferior oblique
• 2. INFERIOR OBLIQUE SURGERY
• 2.1. Weakening procedures
• 2.2. Strengthening procedures
• 2.3. Differential procedures
• 3. SUPERIOR OBLIQUE SURGERY
• 3.1. Temporal approach in surgery on the reflected tendon
• 3.2. Nasal approach in surgery on the reflected tendon
• 3.3. Differential surgery
• 3.4. Adjustable sutures
• 3.5. Surgery on the trochlea
• 4. COMBINED SUPERIOR/INFERIOR OBLIQUE SURGERY
• Chapter 12: Repeat surgery (technical aspects)
• 1. IMMEDIATE REPEAT SURGERY
• 1.1. Anaesthesia
• 1.2. Reopening the conjunctiva and Tenon’s
• 1.3. Muscle surgery
• 1.4. Conjunctiva and Tenon’s sutures
• 2. LATE REPEAT SURGERY
• 2.1. Anaesthesia
• 2.2. Conjunctiva and Tenon’s incision
• 2.3. Isolation of the muscle
• 2.4. Position of the eyes under anaesthesia (EPA) and the muscle stretch test (MST)
• 2.5. Repeat surgery: the procedure itself
• 2.6. Suturing the conjunctiva and Tenon’s
• 3. DISFIGURING CONJUNCTIVA AND TENON’S SCAR TISSUE
• Chapter 13: Use of the microscope in extraocular muscle surgery 251
• 1. SURGICAL ACCURACY FOR MORE PRECISION IN THE AMOUNT OF SURGERY
• 1.1. Using the original insertion as reference point
• 1.2. Minimizing scleral variations
• 1.3. Minimizing muscle variations
• 1.4. Minimizing variations and perfecting the amount of surgery when tying the suture knots
• 2. SPARING OF BLOOD VESSELS IN EXTRAOCULAR MUSCLE SURGERY
• 2.1. Surgical anatomical data
• 2.2. Sparing blood vessels
• Chapter 14: Incidents and complications related to surgical techniques
• 1. INTRAOPERATIVE INCIDENTS AND COMPLICATIONS
• 1.1. Haemorrhages
• 1.2. Incidents and complications involving the muscles
• 1.3. Scleral notches and perforations
• 1.4. Other incidents and complications
• 2. POST-OPERATIVE COMPLICATIONS
• 2.1. Infections
• 2.2. Corneal complications
• 2.3. Bulbar complications
• 2.4. Conjunctival and Tenon’s complications
• 2.5. Muscle and aponeurotic complications
• 2.6. Palpebral complications
• PART THREE: SURGICAL STRATEGY
• Chapter 15: Concomitant strabismus
• 1. THE OCULOMOTOR DISORDER
• 1.1. Classification
• 1.2. The angle of deviation: a question of terminology
• 1.3. Surgical strategy
• 1.4. Choice of surgery
• 2. STRABISMUS WITH ANOMALOUS BINOCULARITY
• 2.1. Esotropia
• 2.2. Exotropia
• 2.3. Accommodative strabismus
• 2.4. Secondary (sensory) strabismus
• 3. NORMO-SENSORIAL STRABISMUS
• 3.1. Normo-sensorial esotropia
• 3.2. Normo-sensorial exotropia
• 3.3. Accommodative esotropia
• 4. EVALUATION OF RESULTS
• 4.1. Evaluation criteria
• 4.2. Motor results
• 4.3. Sensory results
• 5. COSMETIC CRITERIA IN STRABISMUS SURGERY
• 5.1. Cosmetic and functional objectives
• 5.2. Criteria for judging the surgical result
• 6. CONCLUSION
• 6.1. Cure, good or satisfactory result
• 6.2. Insufficient result or failure
• Chapter 16: Nystagmus
• 1. ANALYSIS OF NYSTAGMUS
• 1.1. Clinical examination
• 1.2. Oculography
• 1.3. Presurgical prism adaptation
• 2. CONGENITAL NYSTAGMUS
• 2.1. Classification
• 2.2. Surgical strategy
• 3. MANIFEST-LATENT NYSTAGMUS
• 3.1. Classification
• 3.2. Surgical strategy
• 4. MIXED FORMS OF MANIFEST NYSTAGMUS
• 5. ACQUIRED NYSTAGMUS
• Chapter 17: Paralytic strabismus
• 1. THE OCULOMOTOR DISORDER
• 1.1. Classification
• 1.2. Surgical strategy
• 1.3. Surgical techniques
• 2. STRABISMUS WITH SINGLE-MUSCLE PALSY
• 2.1. Lateral rectus palsy
• 2.2. Single muscle involvement in a third nerve palsy
• 2.3. Superior oblique palsy
• 3. STRABISMUS WITH MULTIPLE MUSCLE INVOLVEMENT
• 3.1. Homonymous two-muscle involvement
• 3.2. Unilateral involvement of two antagonist muscles
• 3.3. Unilateral involvement of two adjacent muscles
• 3.4. Unilateral involvement of more than two muscles
• 4. SUPRANUCLEAR PALSIES WITH STRABISMUS
• 4.1. Double elevator palsy
• 4.2. Prenuclear and supranuclear palsies
• Chapter 18: Restrictive, neuro-myogenic and myogenic disorders
• 1. IMPEDIMENT TO EYE MOVEMENT
• 1.1. Classification
• 1.2. Surgical strategy
• 1.3. Surgical techniques
• 2. CONGENITAL SYNDROMES
• 2.1. Stilling-Duane’s retraction syndrome
• 2.2. Möbius syndrome
• 2.3. Brown’s syndrome
• 2.4. Strabismus fixus
• 3. ACQUIRED MYOPATHIES
• 3.1. Oculomotor disorders in endocrine orbitopathy
• 3.2. Orbital myositis
• 3.3. Oculomotor disorders in high myopia
• 4. IATROGENIC STRABISMUS
• 4.1. Iatrogenic deviations following strabismus surgery
• 4.2. Iatrogenic deviations following retinal detachment surgery
• 4.3. Iatrogenic deviations with other causes
• 5. MUSCLE TRAUMA
• 5.1. Muscle injury
• 5.2. Muscle strain
• 5.3. Muscle contusion
• 6. OCULOMOTOR DISORDERS DUE TO ORBITAL TRAUMA
• 6.1. Oculomotor disorder according to the type of fracture
• 6.2. Surgical strategy
• By way of a conclusion
• Subject index