Congenital and iatrogenic abnormalities of oculomotor muscles — surgical rehabilitation (literature review)
DOI: 10.32364/2311-7729-2025-25-Suppl-6
Yu.I. Trilyudina1, O.A. Shelikhova1, A.G. Zabolotniy1,2
1Krasnodar Branch of the S. Fyodorov Eye Microsurgery Federal State Institution, Krasnodar, Russian Federation
2Kuban State Medical University, Krasnodar, Russian Federation
Strabismus is a severe functional and cosmetic eye disorder in which eyes do not properly align with each other when looking at an object. In Russia, strabismus prevalence is 2-5%, and the value is up to 7% in a pediatric population. Visual dysfunctions and cosmetic defects associated with strabismus have a negative impact on a psychosomatic status, mental and intellectual development, as well as social adaptation of a child. As for adults, the conditions significantly limit an occupational choice and cause torticollis. Moreover, they are combined with positional diplopia that essentially worsens a quality of life. Oculomotor muscles have a relatively constant morphology. Abnormal development of the muscle group is a quite rare condition that is one of causes of congenital strabismus. The absence of one or more oculomotor muscles is a rare disease that should be differentiated from neurogenic oculomotor nerve paralysis. Iatrogenic absence of oculomotor muscles is detected in patients with a history of previously operated strabismus when a surgeon "lost" an oculomotor muscle during the surgery. The congenital abnormality and the iatrogenic condition of the oculomotor apparatus can be surgically managed with transposition of rectus muscles changing a direction of the muscle action. Conventionally, the interventions are performed to treat paralytic strabismus when a function of a paralyzed muscle is significantly impaired. This may be comparable to a similar functional impairment associated with hypoplasia or absence of the muscle. Many surgical methods of rectus muscle transposition are divided into two main groups: muscle splitting interventions and full tendon transposition techniques. A number of surgical techniques to manage paralytic strabismus used in a global clinical strabismological practice and reported in the review have a significant list of essential disadvantages. The subject bibliographic analysis of national and foreign papers focused on absence or hypoplasia of extraocular muscles (i. e., one of polyetiologic causes of strabismus) determines a relevance of further studies on surgical rehabilitation of the patients (in particular, development of surgical techniques without the above-mentioned disadvantages).
Keywords: strabismus, oculomotor muscle hypoplasia, absence of oculomotor muscles, loss of oculomotor muscles.
For citation: Trilyudina Yu.I., Shelikhova O.A., Zabolotniy A.G. Congenital and iatrogenic abnormalities of oculomotor muscles — surgical rehabilitation (literature review). Russian Journal of Clinical Ophthalmology. 2025;25(Special Issue):43–48 (in Russ.). DOI: 10.32364/2311-7729-2025-25-Suppl-6
About the authors:
Yulia I. Trilyudina — Ophthalmologist, Children's Vision Protection Office, Krasnodar Branch of the S. Fyodorov Eye Microsurgery Federal State Institution; 6, Krasnykh Partizan str., Krasnodar, 350012, Russian Federation; ORCID iD 0000-0002-8601-2058
Oksana A. Shelikhova — Ophthalmologist, Children's Vision Protection Office, Krasnodar Branch of the S. Fyodorov Eye Microsurgery Federal State Institution; 6, Krasnykh
Partizan str., Krasnodar, 350012, Russian Federation; ORCID iD 0000-0002-3990-0888
Alexander G. Zabolotniy — C. Sc. (Med.), Assistant Professor, Chief Scientific Officer of the Scientific Department, Krasnodar Branch of the S. Fyodorov Eye Microsurgery Federal State Institution; 6, Krasnykh Partizan str., Krasnodar, 350012, Russian Federation; Assistant Professor of the Department of Eye Diseases, Kuban State Medical University; 4, Mitrofan Sedin str., Krasnodar, 350063, Russian Federation; ORCID iD 0000-0002-6022-1708
Contact information: Yulia I. Trilyudina, e-mail: yulya.trilyudina.82@bk.ru
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
Conflict of interest: no conflict of interest.
Received 05.12.2024.
Revised 25.12.2024.
Accepted 22.01.2025.
2. Маркова Е.Ю., Авакянц Г.В. Лечение несодружественного косоглазия у детей. В кн.: материалы научной конференции с международным участием «Невские горизонты — 2020». Санкт-Петербург. СПб.: ООО «Пиастр Плюс»; 2020:108–109. (Электронный ресурс.) URL: https://www.elibrary.ru/download/elibrary_44051823_27238595.pdf (дата обращения: 03.12.2024).Markova E.Y., Avakyants G.V. Treatment of incomitant strabismus in children. In: Materials of the scientific conference with international participation "Nevskie Horizonti — 2020". St. Petersburg. "Piastr Plus" LLC; 2020:108–109. (Electronic resource.) URL: https://www.elibrary.ru/download/elibrary_44051823_27238595.pdf (access date: 03.12.2024) (in Russ.).
3. Катаргина Л.А., ред. Детская офтальмология. Федеральные клинические рекомендации. М.; 2016.Katargina L.A., ed. Pediatric ophthalmology. Federal clinical recommendations. M.; 2016 (in Russ.).
4. Маркова Е.Ю. Современные тенденции лечения косоглазия у детей. Офтальмология. 2016;13(4):260–264. DOI: 10.18008/1816-5095-2016-4-260-264Markova E.Y. Modern trends in the treatment of strabismus in children. Ophthalmology. 2016;13(4):260–264 (in Russ.). DOI: 10.18008/1816-5095-2016-4-260-264
5. Ларионова О.В., Дравица Л.В. Современный взгляд на эпидемиологию и этиопатогенез содружественного косоглазия. Проблемы здоровья и экологии. 2019;3(61):12–17. DOI: 10.51523/2708-6011.2019-16-3-2Larionova O.V., Dravitsa L.V. The modern view on the epidemiology and etiopathogenesis of concomitant strabismus. Problems of Health and Ecology. 2019;3(61):12–17 (in Russ.). DOI: 10.51523/2708-6011.2019-16-3-2
6. Elflein H.M. Amblyopie. Ophthalmologe. 2016;113(4):283–288. DOI: 10.1007/s00347-016-0247-3
7. Niyaz L., Gul A., Ariturk N. Frequency and etiology of paralytic strabismus. Austin J Clin Ophthalmol. 2015;2(1):1–2.
8. Плисов И.Л., Черных В.В. Паралитическое косоглазие: клиника, диагностика, лечение. М.: Офтальмология; 2018.Plisov I.L., Chernykh V.V. Paralytic strabismus: clinic, diagnostics, treatment. M.: Ophthalmology; 2018 (in Russ.).
9. Buffen A.N. The impact of strabismus on psychological health and quality of life: a systematic review. Survey Ophthalmol. 2021;66(6):1051–1064. DOI: 10.1016/j.survophthal.2021.03.00
10. Shumway C.L., Motlagh M., Wade M. Anatomy, Head and Neck: Eye Inferior Rectus Muscle. Treasure Island (FL): StatPearls Publishing; 2025. PMID: 30085520
11. Nayak S.B., Shetty S.D., Kumar N., Aithal A.P. Double-bellied superior rectus muscle. Surgical Radiologic Anatomy. 2019;41(6):713–715. DOI: 10.1007/s00276-019-02211-0
12. Bhate M. Double-bellied inferior rectus muscles with aplasia of medial rectus muscles. J AAPOS. 2024;28(1):103–798. DOI: 10.1016/j.jaapos.2023.09.009
13. Sheth J., Shinde A., Kekunnaya R. Congenital anomalies of inferior rectus and its surgical outcomes. Strabismus. 2022;30(3):150–158. DOI: 10.1080/09273972.2022.2098989
14. Lee S.B., Yoon Y.H. Bilateral absence of the inferior rectus muscle presenting with pseudoptosis: treatment of a novel presentation. J AAPOS. 2016;20(6):550–552. DOI: 10.1016/j.jaapos.2016.07.231
15. Decer M., Cassiman C., Casteels I. et al. Extraocular muscle hypoplasia associated with Axenfeld-Rieger syndrome. Strabismus. 2021;29(4):216–220. DOI: 10.1080/09273972.2021.1987926
16. Taylor R.H., Kraft S.P. Aplasia of the inferior rectus muscle. A case report and review of the literature. Ophthalmology. 1997;104(3):415–418. DOI: 10.1016/s0161-6420(97)30299-1
17. Matsuo T., Watanabe T., Furuse T. et al. Case report and literature review of inferior rectus muscle aplasia in 16 Japanese patients. Strabismus. 2009;17(2):66–74. DOI: 10.1080/09273970802687504
18. Zöller C.C., Gräf M., Kaufmann H. Einseitige Aplasie eines Musculus rectus lateralis Unilateral aplasia of a lateral rectus muscle. Klin Monbl Augenheilkd. 2001;218(1):55–60. DOI: 10.1055/s-2001-11262
19. Pimenides D., Young S., Minty I. et al. Familial aplasia of the inferior rectus muscles. J Pediatr Ophthalmol Strabismus. 2005;42(4):222–227. DOI: 10.3928/01913913-20050701-04
20. Хамраева Л.С., Мавлянов М.Ш., Бобоха Л.Ю. Клинический случай наблюдения больного с аномалией глазодвигательных мышц при перинатальном поражении центральной нервной системы. Российская педиатрическая офтальмология. 2015;2:41–43.Khamraeva L.S., Mavlyanov M.Sh., Bobokha L.Y. Clinical case of observation of a patient with anomaly of oculomotor muscles in perinatal lesion of the central nervous system. Russian Pediatric Ophthalmology. 2015;2:41–43 (in Russ.).
21. Sharma P., Chaurasia S., Rasal A. Bilateral medial rectus aplasia and a modified surgical approach of transposition myopexy of vertical recti. BMJ Case reports. 2017:bcr2017220404. DOI: 10.1136/bcr-2017-220404
22. Пузыревский К.Г., Анциферова Н.Г., Плисов И.Л. Клинические случаи аплазии нижних прямых мышц. «Федоровские чтения — 2009». Раздел 6. Патология глазодвигательного аппарата. (Электронный ресурс.) URL: https://eyepress.ru/material/-klinicheskie-sluchai-aplazii-nizhnikh-pryamykh-myshts- (дата обращения: 03.12.2024).Puzyrevsky K.G., Antsiferova N.G., Plisov I.L. Clinical cases of aplasia of lower rectus muscles. "Fedorov Readings — 2009". Section 6. Pathology of the oculomotor apparatus (Electronic resource.) URL: https://eyepress.ru/material/-klinicheskie-sluchai-aplazii-nizhnikh-pryamykh-myshts- (access date: 03.12.2024) (in Russ.).
23. Diamond G.R., Katowitz J.A., Whitaker L.A. Variations in extraocular muscle number and structure in craniofacial dysostosis. Am J Ophthalmol. 1980;90:416–418. DOI: 10.1016/S0002-9394(14)74927-X
24. Lee A.R., Clark R.A., Suh D.W. et al. Strabismus Surgery Complications. 2024.
25. Olitsky S.E., Coats D.K. Complications of Strabismus Surgery. Middle East Afr J Ophthalmol. 2015;(22):271–278. DOI: 10.4103/0974-9233.159692
26. Chen S.I., Knox P.C., Hiscott P. et al. Detection of the Slipped Extraocular Muscle After Strabismus Surgery. Ophthalmol. 2005;112(4):686–693. DOI: 10.1016/j.ophtha.2004.11.048
27. Coats D.K., Olitsky S.E. et al. Slipped and Lost Muscles. In: Coats D.K., Olitsky S.E. Strabismus Surgery and Its Complications. Springer Science & Business Media. 2007;233–246.
28. Ellis E.M., Kinori M., Robbins S.L., Granet D.B. Pulled-in-two syndrome: a multicenter survey of risk factors, management and outcomes. J AAPOS. 2016;(20):387–391. DOI: 10.1016/j.jaapos.2016.06.004
29. Chatzistefanou K.I., Kushner B.J., Gentry L.R. Magnetic resonance imaging of the arc of contact of extraocular muscles: implications regarding the incidence of slipped muscles. J AAPOS. 2000;(4):84–93. DOI: 10.1067/mpa.2000.103434
30. Oke I., Lorenz B., Basiakos S. et al. Nasal transposition of the split lateral rectus muscle for strabismus associated with bilateral third nerve palsy. Am J Ophthalmol. 2022;242:165–172. DOI: 10/1016/j.ajo.2022.06.010
31. Goldberg R.A. Is there a "lost" rectus muscle in strabismus surgery? Am J Ophthalmol. 2001;132:101–103. DOI: 10.1016/s0002-9394(01)01019-4
32. Bagheri A., Abbaszadeh M., Tavakoli M. Medial rectus muscle loss: Is immediate lateral rectus disinsertion a solution? A case report with review of the literature. J Curr Ophthalmol. 2018;31(3):349–352. DOI: 10.1016/j.joco.2018.10.010
33. Пасикова Н.В., Кузнецов И.В. Некоторые осложнения хирургии косоглазия. Обзор литературы. Точка зрения. Восток — Запад. 2022;3:45–49. DOI: 10.25276/2410-1257-2022-3-45-49Pasikova N.V., Kuznetsov I.V. Some complications of strabismus surgery. Literature review. Point of view. East-West. 2022;3:45–49 (in Russ.). DOI: 10.25276/2410-1257-2022-3-45-49
34. Arfeen S., Azzab M., Saad Z. et al. Comparison between Hummelsheim and Jensen procedures in the management of chronic sixth nerve palsy. Graefes Arch Clin Exp Ophthalmol. 2022;260:63–369. DOI: 10.1007/s00417-021-05352-4
35. Аветисов С.Э., Данилов С.С., Шалтынов А.С. Хирургия косоглазия и синдром ишемии переднего сегмента глаза. Вестник офтальмологии. 2019;135(3):99–103. DOI: 10.17116/oftalma201913503199Avetisov S.E., Danilov S.S., Shaltynov A.S. Strabismus surgery and anterior segment ischemia syndrome. Ophthalmology Bulletin. 2019;135(3):99–103 (in Russ.). DOI: 10.17116/oftalma201913503199
36. Baghery A., Tavakoli M., Torbati P. et al. Natural course of anterior segment ischemia after disinsertion of extraocular rectus muscle in an animal model. J AAPOS. 2013;17:395–401. DOI: 10.1016/j.jaapos.2013.05.010
37. Oltra E.Z., Pineles S.L., Demer J.L. et al. The effect of rectus muscle recession, resection and plication on anterior segment circulation in humans. Br J Ophthalmol. 2015;99(4):556–560. DOI: 10.1136/bjophthalmol-2014-305712
38. Tibrewal S., Kekunnaya R. Risk of anterior segment ischemia following simultaneous three rectus muscle surgery: results from a single Tertiary Care Centre. Strabismus. 2018;26(2):77–83. DOI: 10.1080/09273972.2018.1450429
39. Wan M.J., Hunter D.G. Complications of strabismus surgery: incidence and risk factors. Semin Ophthalmol. 2014;5:421–428. DOI: 10.3109/08820538.2014.959190
40. Пузыревский К.Г., Анциферова Н.Г. Способ лечения вторичного косоглазия. Патент RU 2 407 492 C1. Опубл. 27.12.2010.Puzyrevsky K.G., Antsiferova N.G. Method for treating secondary strabismus. Patent RU 2 407 492 C1. Published 27.12.2010 (in Russ.).
41. Akar S., Gokyigit B., Ozturker Z. Combined rectus muscle transposition with posterior fixation sutures (Augmented Knapp Procedure) for the surgical treatment of double elevator palsy. J Pediatric Ophthalmol Strabismus. 2022;59(1):17–23. DOI: 10.3928.01913913-2021070702
42. Maurino V., Kwan A.S.L., Lee J.P. Review of the inverse Knapp procedure: Indications, effectiveness and results. Eye. 2001;15(1):7–11. DOI: 10.1038/eye.2001.4
This work is licensed under a Creative Commons «Attribution» 4.0 License.
