Free Tenotomy In Very Large Angle Horizontal Strabismus.
FHEE TEM@T@ffi]V [ffi UERV LFIHEE
HIMELE H@RIUBMTIFIL ETRRB[5MUEi
I-lUSLli'f
T={EDICAL FACULTY OF ANDAI.AS UNI(.IERSITY
FADAi.IG
- INDONESIA
FREE TENOTOf"iY IT.I VERY LARGE
ANGLE HORIZDNTAL STRAEIS!,,IUS
( Ca=e report
)
INTRODUCTItrN
Dief errbach (7 ,z ) in tr-r-.rcrrced
f ree tenotoi:rry f er the
first time in 1848,'The re=ult
of this procedr_tre Fr€.=. often
an
Everccr.rection, and becan= unpoF,Ltla-r-.In
1g=f, woit Greefe (?17)
revi'red this procedure by inpravin'--r
the- snrg'ca.r 'r--schniq.re.
Fr-rt the
re=*lt
r^iE= =till
cii=,;lFpoLnting, becalrse of
it=-r t-tnpredictahilrty.
Free tanntamy pra.s then re,plareC
by
rece=='icn (Frince 1gs7) Thie praceiir-r
r= Fr,_=\,ent= e;.:c*==:.ve
relrac'ticn
ertr perrnits,-lr-a.din,=r cf Ltis i^,re:i[.1
s'i11-; g e-ffeci_.
i3)
d*.,i .ir.-Ec- ren-ntciny., l_=. ri I
i ii_r Lt=-L= f af
=
Ltnlle-ilal case=, sr:ch ;'E:
- A-ti patternr ('tenotci-ry af the obllqr_re
_T a
,nLis.--res). t7 l'-'lr
lEl-r
- lY*iji.-il rectlr= p=1 t-p:ji=." ( tenntcm;_, r__if .rir=
iateral
rec iu=
flLr=trle). (?17)
'+;-iiiilgip.r
.
to
ThyroicJ myopathy.
5'cral:ii sniLr_=. f iillr=.
(
tent:tcniy nf
i ieri c t'-:fit;.,
_n
f
1:h= inferir.-.rr. i-ec tur=
t lr,--
fni]-rrr
-i_
a.l. i-=r
i-
ti
7.t
)
.'t
L:j
Cageg r.rrith very large angle
r4ere special
iicr i- i
prohlerr. Ma=t of these
rrn'l:a.
re=F=
I
de
v,i
at ior.,
neeti eilces=ive
rnanagement =t_rch as I
operati.on on the far_rr hori=ontaJ rec tr-t= rrrtrsc es . (f,.5!7.8)
large
birnedial
FetrEEs:_on in
e=ctropia . (6r?r11)
_1.
e,'lces=ive t-ecess-resect in e:lotropi :i
(7.8 )
true tran=position
strabisrnLrs.
procedrlr-e ag
r+i
i.h deep -rmblyopia,
rEoperatian
rn rectti-ren t
(1)
Fotrr caseg
of fr=e teFrctcirr.,, in ver.rt i=-rrge 'Entr 1 e
hc:ri zcrn'r-*. I sti-abisrnns ( devietitn
angle 7=, Fr: Si-': d i'_rpter=
cr- irroFe ) f Or- co=.rnetic F!-rrpt--rsf- i+i- I i b= Fr€=.en ted .
Surgical procedure.
The
rnu=.c
Con
j Lrntrt i val
1e
r.JgE
di='='ectioning
Af
sever-e,j
mu_qc
enta-qnnl=.'r
.!!Lr=.':
i.Jiii:i .:.i.i.f!t-is.i.
t:ri
I
i t'=
irrrbal
aFtrr-oach,
in-qertrnn
f
a=rrhr---rn'?
l:; l.
r.llt_hsr_rt
t
,
l=._ t:lre runjunct i ve an'j Tenon '= cspsril
e
t^liti-rL,Llt
=uttltred
l
r.JErE
at
the interr*lr=cLrra.r
ter cr-rtting the
i.*ib--r-E:
inc i = j_on
f =r==.g'ic'n *
e,,-,';.s i-==.;,,:.!-=,:i
,;i-;E ei.,Lri
r-rn.l:i
i
lJn
.i_-.r-,i=
aii_! i-=E=,_.i.:-i.ir:_r !.,ri:=
h---:r.:
_i.
r_-l
aJrrEn
tl-i|.-u=e {=ru==,,
p'ri---:_i_
.-J
l-:
1-.r
-_
tit-,i-r i::f .i:i-re
_
i i l=
"
't11E
El;.,f:,
-:-
CASE REPORTS
case 1' A 4 !/?-year--ord
tha.t
the
left
girl
eye
r cofiFlained
tr_rrned
in
by her
parent=
since + years
Ego.
E:Eti an
Lr-r th= an t;.gsn f 5.1 ;nn=c
1e:
in the fo'-t r ca=esq !^JG.=.
Lra=ed trn Scr-:tt '= principie.
snd fsr-
cctsmetic FLri-p{_-iseE on i i,- .
Ea'ge an the ste,ge cLrre of
Ahiyama.
( 1{-))
-T r-c-r9pg.,LniJ,i.n
, therse resur.t
!_--,r.1
r..Jere rL--.,smetic;.
!:? f:li!li_,::i_rtl_ri:rpii,:r_i.;i.i"i.._,r-
35 pr-ism diapter=- --rt d1=t.rn t
The
folLoi+
LtF
ti.rrrr:
=.f-rr.hi=rrn=. hy Uemrnra
+-Jere r.j=s
!r.r:-r=e- trcl
1
iy
!_,1,fj.,=li_
sati=-ia,.tary
in
=ii:.j i:illj:!_,_ip:-.r..;f
=.ti I i pre=.=n
i.'r-ii-,_h=
E.
.,_L_L
L
=
r-ri-r
t+
o=__r.
11
Accarding
tenotorry
to
litersturE=.i
r{as unpredj.ctabie.
the
re=lrl-u
of
free
Anyhou; in
ver_)/ la.rge anqle
hori=onta1 strabisrnlrs
it rnsy be LrsE with cc,srnetical ly
satisfactory
r-egult, If rrnder or_ overcor_rect_jsip
f_esLrLtecJ
later! r\,e coltlcl reoperate .on the good
nirr=cIe oi the other
e'e'
o
The advantage sf this prccedure are:
1 ' r t can irranegE oF ccrrect
vEr\r, r arge eng re harizonts 1
strabismr-ts r^,rith rnani-pr-rration oi tr.la
riLi=:cr.eE in ene EyE
only"
2. The apEr--itian is fa=trr :,nd easieF
ta dn.
f,. Less ena€-ihstrc and oFerat:_an ri=F;.
4
'
f reaFEre'trqn is n=ed=d. it couid
sound ( un =ca i-red ) eye .
r
be rit-ine in the nther
5, Lout cost
FESUI'IE
Free tsnotnmy r'lif-h trrr r.;ithor-it r-=::ertian
,--n the
antagarri-=:t n-rr-t=c1e hg=. r',Er=n prEsb=nf_r-,j.
The re=r_tr..i_ i.jErLi'=
c'-rsrne'tir=11;:
=.+t-r_Efactcr.-;=,_ alrr.l=.t t_h=
..:-ii; i+l-r;..'1._ i_:ad br:eri
=.r.rriij
:C tri;":',,rlii !_:',.
EL-.rr-iir:
i'jii*'l--iier
i..ili.-: i't.i'i-t'-t.,,
alt thAi_=.
.
'r:ii* fii-'',.-erri
it
i''i* t*:i.rl
L:e LrEnliijr..:j.r..,
'i'iti,--i:,i'ir::,t- t,:-i-t.,tr..liii.r:*
i...i-i.i.i i--i*.: ii_;:,r:itit-i"
.Lr_,-r_:,;..,rs:rij
...,i_:
1T
LITERATURE
l. Diemond E.R,
: Trure transpositign
?. Dul,;e-Elder S.S :
procedrrre=.
J . Fediatr.
Ophtha lrnol " Strab i srnus
77 : 15.1
lF6" t??O"
Ocu I
ar- moti I i ty and Str-abiErnu=.
Vol . VI . He,nry Fiirnpton London
"
+?7
3.
He I
+"
l,!_na.pF F,,
veston
E.
4?Bt L?7b.
: Atla.s of strat,i=nrlr= Surgery.
The C. V " I"losby Dompany. _St. Lor_r i s. l"li=socrri
sec. ed : Eg 6(r t IS77 "
l-J
: Lc=t
l,lr_r=cle.
I
n
'f
rensacti on of the
S;,.n-rposilrm Dn Si_rebi=.r*rr_rs.
Orleans Acaderny, ef
l,Jer:
Ophth:rlr;s1t:g-vo The C.V. i.!o=.hy Compa-ny.
St. Lar-ris ..
J{14, L?7A.
5" Le= D.A
E:r
D.7,er
=(:r1
-r , A : Bi l aterai
media i r-ectr_rs recegsion
c-r'.-d laterar. i-eq'Ltr= r,'r*sc ies FeSectir_.rn
in
+_he
A
6,
Ne
1e.crr
i_ . E
-.T,
et al ".
treatmen t urf
G. ?i : i?E
Dongen.i t;.. 1.
5L(t.'/e;J
l"lr:ur|j--i'i
f-1
"!'..u"
trtrr.igen
lf,i,
i t*1 esotrapia.
1?Bf,.
E.;otrc,pia.
Opl-r't:fi.e1r.rra.r
"
f;
l- : _i6_1 jBf,"
: F-ir-rr-r-=.r-! '.Ji:,ii i.ii.i,-,!,-LrF-iii'._: ii-i.ncri:iri.*r
+ri,j Ori.ri;ir- i.1,:t-i i i .i:.
"
r
l_gg7_
v:.=.-r.Lrri
A. Parl'ls
Fcular I'iotility
f.1.1"1.
and StrabismLrs.
l'ledicaI Departement Har-per and
Hager=to!.,rn ! f'laryl and
,
121
Ror^1,
! tg73 .
9. Scott W.E. et al : Surrgery tor large-angle congenital
e=otrcpia.
Arch Ophthalrnol.
lCt.Uernr-rra Y. &. Al.;iyama l.:. : Criteria
11 . !4ea.l,:.1ey
et
a
i
: .174
1t-l4
A7g, 1?86.
f-or ct-tre in strabisrnLrs,
J.Qcr_rl. Ther. Sr_rrg. 4 : 8O - A?, lgES.
: Seven rrri 1 irneter bL l ateral medi al rectlrs
rec=sgisn in infantil
J, Fediatr. Ophthelr.riol
2A : li.l
11i. I?qt.
e=atropj.a.
.
Srrabismurs,
HIMELE H@RIUBMTIFIL ETRRB[5MUEi
I-lUSLli'f
T={EDICAL FACULTY OF ANDAI.AS UNI(.IERSITY
FADAi.IG
- INDONESIA
FREE TENOTOf"iY IT.I VERY LARGE
ANGLE HORIZDNTAL STRAEIS!,,IUS
( Ca=e report
)
INTRODUCTItrN
Dief errbach (7 ,z ) in tr-r-.rcrrced
f ree tenotoi:rry f er the
first time in 1848,'The re=ult
of this procedr_tre Fr€.=. often
an
Everccr.rection, and becan= unpoF,Ltla-r-.In
1g=f, woit Greefe (?17)
revi'red this procedure by inpravin'--r
the- snrg'ca.r 'r--schniq.re.
Fr-rt the
re=*lt
r^iE= =till
cii=,;lFpoLnting, becalrse of
it=-r t-tnpredictahilrty.
Free tanntamy pra.s then re,plareC
by
rece=='icn (Frince 1gs7) Thie praceiir-r
r= Fr,_=\,ent= e;.:c*==:.ve
relrac'ticn
ertr perrnits,-lr-a.din,=r cf Ltis i^,re:i[.1
s'i11-; g e-ffeci_.
i3)
d*.,i .ir.-Ec- ren-ntciny., l_=. ri I
i ii_r Lt=-L= f af
=
Ltnlle-ilal case=, sr:ch ;'E:
- A-ti patternr ('tenotci-ry af the obllqr_re
_T a
,nLis.--res). t7 l'-'lr
lEl-r
- lY*iji.-il rectlr= p=1 t-p:ji=." ( tenntcm;_, r__if .rir=
iateral
rec iu=
flLr=trle). (?17)
'+;-iiiilgip.r
.
to
ThyroicJ myopathy.
5'cral:ii sniLr_=. f iillr=.
(
tent:tcniy nf
i ieri c t'-:fit;.,
_n
f
1:h= inferir.-.rr. i-ec tur=
t lr,--
fni]-rrr
-i_
a.l. i-=r
i-
ti
7.t
)
.'t
L:j
Cageg r.rrith very large angle
r4ere special
iicr i- i
prohlerr. Ma=t of these
rrn'l:a.
re=F=
I
de
v,i
at ior.,
neeti eilces=ive
rnanagement =t_rch as I
operati.on on the far_rr hori=ontaJ rec tr-t= rrrtrsc es . (f,.5!7.8)
large
birnedial
FetrEEs:_on in
e=ctropia . (6r?r11)
_1.
e,'lces=ive t-ecess-resect in e:lotropi :i
(7.8 )
true tran=position
strabisrnLrs.
procedrlr-e ag
r+i
i.h deep -rmblyopia,
rEoperatian
rn rectti-ren t
(1)
Fotrr caseg
of fr=e teFrctcirr.,, in ver.rt i=-rrge 'Entr 1 e
hc:ri zcrn'r-*. I sti-abisrnns ( devietitn
angle 7=, Fr: Si-': d i'_rpter=
cr- irroFe ) f Or- co=.rnetic F!-rrpt--rsf- i+i- I i b= Fr€=.en ted .
Surgical procedure.
The
rnu=.c
Con
j Lrntrt i val
1e
r.JgE
di='='ectioning
Af
sever-e,j
mu_qc
enta-qnnl=.'r
.!!Lr=.':
i.Jiii:i .:.i.i.f!t-is.i.
t:ri
I
i t'=
irrrbal
aFtrr-oach,
in-qertrnn
f
a=rrhr---rn'?
l:; l.
r.llt_hsr_rt
t
,
l=._ t:lre runjunct i ve an'j Tenon '= cspsril
e
t^liti-rL,Llt
=uttltred
l
r.JErE
at
the interr*lr=cLrra.r
ter cr-rtting the
i.*ib--r-E:
inc i = j_on
f =r==.g'ic'n *
e,,-,';.s i-==.;,,:.!-=,:i
,;i-;E ei.,Lri
r-rn.l:i
i
lJn
.i_-.r-,i=
aii_! i-=E=,_.i.:-i.ir:_r !.,ri:=
h---:r.:
_i.
r_-l
aJrrEn
tl-i|.-u=e {=ru==,,
p'ri---:_i_
.-J
l-:
1-.r
-_
tit-,i-r i::f .i:i-re
_
i i l=
"
't11E
El;.,f:,
-:-
CASE REPORTS
case 1' A 4 !/?-year--ord
tha.t
the
left
girl
eye
r cofiFlained
tr_rrned
in
by her
parent=
since + years
Ego.
E:Eti an
Lr-r th= an t;.gsn f 5.1 ;nn=c
1e:
in the fo'-t r ca=esq !^JG.=.
Lra=ed trn Scr-:tt '= principie.
snd fsr-
cctsmetic FLri-p{_-iseE on i i,- .
Ea'ge an the ste,ge cLrre of
Ahiyama.
( 1{-))
-T r-c-r9pg.,LniJ,i.n
, therse resur.t
!_--,r.1
r..Jere rL--.,smetic;.
!:? f:li!li_,::i_rtl_ri:rpii,:r_i.;i.i"i.._,r-
35 pr-ism diapter=- --rt d1=t.rn t
The
folLoi+
LtF
ti.rrrr:
=.f-rr.hi=rrn=. hy Uemrnra
+-Jere r.j=s
!r.r:-r=e- trcl
1
iy
!_,1,fj.,=li_
sati=-ia,.tary
in
=ii:.j i:illj:!_,_ip:-.r..;f
=.ti I i pre=.=n
i.'r-ii-,_h=
E.
.,_L_L
L
=
r-ri-r
t+
o=__r.
11
Accarding
tenotorry
to
litersturE=.i
r{as unpredj.ctabie.
the
re=lrl-u
of
free
Anyhou; in
ver_)/ la.rge anqle
hori=onta1 strabisrnlrs
it rnsy be LrsE with cc,srnetical ly
satisfactory
r-egult, If rrnder or_ overcor_rect_jsip
f_esLrLtecJ
later! r\,e coltlcl reoperate .on the good
nirr=cIe oi the other
e'e'
o
The advantage sf this prccedure are:
1 ' r t can irranegE oF ccrrect
vEr\r, r arge eng re harizonts 1
strabismr-ts r^,rith rnani-pr-rration oi tr.la
riLi=:cr.eE in ene EyE
only"
2. The apEr--itian is fa=trr :,nd easieF
ta dn.
f,. Less ena€-ihstrc and oFerat:_an ri=F;.
4
'
f reaFEre'trqn is n=ed=d. it couid
sound ( un =ca i-red ) eye .
r
be rit-ine in the nther
5, Lout cost
FESUI'IE
Free tsnotnmy r'lif-h trrr r.;ithor-it r-=::ertian
,--n the
antagarri-=:t n-rr-t=c1e hg=. r',Er=n prEsb=nf_r-,j.
The re=r_tr..i_ i.jErLi'=
c'-rsrne'tir=11;:
=.+t-r_Efactcr.-;=,_ alrr.l=.t t_h=
..:-ii; i+l-r;..'1._ i_:ad br:eri
=.r.rriij
:C tri;":',,rlii !_:',.
EL-.rr-iir:
i'jii*'l--iier
i..ili.-: i't.i'i-t'-t.,,
alt thAi_=.
.
'r:ii* fii-'',.-erri
it
i''i* t*:i.rl
L:e LrEnliijr..:j.r..,
'i'iti,--i:,i'ir::,t- t,:-i-t.,tr..liii.r:*
i...i-i.i.i i--i*.: ii_;:,r:itit-i"
.Lr_,-r_:,;..,rs:rij
...,i_:
1T
LITERATURE
l. Diemond E.R,
: Trure transpositign
?. Dul,;e-Elder S.S :
procedrrre=.
J . Fediatr.
Ophtha lrnol " Strab i srnus
77 : 15.1
lF6" t??O"
Ocu I
ar- moti I i ty and Str-abiErnu=.
Vol . VI . He,nry Fiirnpton London
"
+?7
3.
He I
+"
l,!_na.pF F,,
veston
E.
4?Bt L?7b.
: Atla.s of strat,i=nrlr= Surgery.
The C. V " I"losby Dompany. _St. Lor_r i s. l"li=socrri
sec. ed : Eg 6(r t IS77 "
l-J
: Lc=t
l,lr_r=cle.
I
n
'f
rensacti on of the
S;,.n-rposilrm Dn Si_rebi=.r*rr_rs.
Orleans Acaderny, ef
l,Jer:
Ophth:rlr;s1t:g-vo The C.V. i.!o=.hy Compa-ny.
St. Lar-ris ..
J{14, L?7A.
5" Le= D.A
E:r
D.7,er
=(:r1
-r , A : Bi l aterai
media i r-ectr_rs recegsion
c-r'.-d laterar. i-eq'Ltr= r,'r*sc ies FeSectir_.rn
in
+_he
A
6,
Ne
1e.crr
i_ . E
-.T,
et al ".
treatmen t urf
G. ?i : i?E
Dongen.i t;.. 1.
5L(t.'/e;J
l"lr:ur|j--i'i
f-1
"!'..u"
trtrr.igen
lf,i,
i t*1 esotrapia.
1?Bf,.
E.;otrc,pia.
Opl-r't:fi.e1r.rra.r
"
f;
l- : _i6_1 jBf,"
: F-ir-rr-r-=.r-! '.Ji:,ii i.ii.i,-,!,-LrF-iii'._: ii-i.ncri:iri.*r
+ri,j Ori.ri;ir- i.1,:t-i i i .i:.
"
r
l_gg7_
v:.=.-r.Lrri
A. Parl'ls
Fcular I'iotility
f.1.1"1.
and StrabismLrs.
l'ledicaI Departement Har-per and
Hager=to!.,rn ! f'laryl and
,
121
Ror^1,
! tg73 .
9. Scott W.E. et al : Surrgery tor large-angle congenital
e=otrcpia.
Arch Ophthalrnol.
lCt.Uernr-rra Y. &. Al.;iyama l.:. : Criteria
11 . !4ea.l,:.1ey
et
a
i
: .174
1t-l4
A7g, 1?86.
f-or ct-tre in strabisrnLrs,
J.Qcr_rl. Ther. Sr_rrg. 4 : 8O - A?, lgES.
: Seven rrri 1 irneter bL l ateral medi al rectlrs
rec=sgisn in infantil
J, Fediatr. Ophthelr.riol
2A : li.l
11i. I?qt.
e=atropj.a.
.
Srrabismurs,