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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest Alternate Remedy For Medial Rectus Palsy

I am 23 yrs old, 5 feet 7 inches tall, weight ~65 kgs and have undergone two strabismus surgeries on my right eye at the age of 1 and 22. I have ambloypia and esotropia in my right eye since birth and the first operation at the age of 1 was a failure. After that, my right eye has been a little inwards and downwards in the same position for 22 years and hardly noticeable. Last year, I decided to correct the inward squint for cosmetic reasons, which I consider my biggest mistake till date. After the surgery, my right eye is now turning outwards and downwards plus it won't move towards the nose anymore and is stuck in the center even when I look towards the left side with the right eye. I have consulted another strabismologist who, after performing a forced duction test, diagnosed it as a medial rectus palsy, and recommended another surgery on the MR and LR of the right eye itself with the adjustable suture method. I am very skeptical of going for another surgery now and don't know what will be the outcome. Referring to various strabismus websites online, I think that correcting a post-operative medial rectus palsy after a squint surgery can be particularly unsatisfactory because of the difficulty of locating the broken/slipped muscle, etc. I have also read about pre-operative CT scans to locate the muscle. Also, I have read about some "transposition surgery" which can be performed, but not sure about how satisfactory that would be either. One website mentions transposition surgeries are more satisfactory, another one mentions they're disappointing. I don't know what to do, and before deciding so, want to be completely sure of the best path to take.
Mon, 29 Sep 2014
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Ophthalmologist 's  Response
alternative treatment for such problem not known. i have gone through your detail history. correct steps have been taken. Every surgery has got some failure rate. trans position sur gery is possible. but it must be done by expert who have done such surgery in past. proper cal calculation is to be done before surgery.should report to hospital having separate squint depart ment. It is a difficult procedure slight mistake in calculation will give erroneous result.
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Suggest Alternate Remedy For Medial Rectus Palsy

alternative treatment for such problem not known. i have gone through your detail history. correct steps have been taken. Every surgery has got some failure rate. trans position sur gery is possible. but it must be done by expert who have done such surgery in past. proper cal calculation is to be done before surgery.should report to hospital having separate squint depart ment. It is a difficult procedure slight mistake in calculation will give erroneous result.