title: Strabismus and mitochondrial defects in chronic progressive external ophthalmoplegia.
abstract: OBJECTIVE
  To describe the results of strabismus surgery on three patients with chronic progressive external ophthalmoplegia, a group of rare disorders characterized by ptosis and slowly progressive ophthalmoparesis that has been shown to result from defects in mitochondrial DNA.
  
  
  METHODS
  Strabismus surgery using the adjustable suture technique was performed in three patients with strabismus and chronic progressive external ophthalmoplegia confirmed by clinical, biochemical, histopathologic, and genetic criteria. All three patients had mitochondrial DNA deletions. Two patients were exotropic; one patient was esotropic.
  
  
  RESULTS
  Rectus muscle recessions were initially unsuccessful in correcting strabismus in one patient, although a subsequent procedure employing rectus muscle resections was successful in alleviating a significant head turn and improved ocular alignment. In the two other patients, a single procedure consisting of rectus muscle recessions combined with large rectus muscle resections successfully achieved good postoperative alignment. The amount of surgery performed in these three patients exceeded that predicted in standard strabismus tables.
  
  
  CONCLUSIONS
  The myopathic process that results in chronic progressive external ophthalmoplegia renders rectus muscle recessions less effective compared with resections for correcting the associated strabismus seen in these patients. Rectus muscle resections therefore should be an integral procedure in the surgical management of the strabismus associated with chronic progressive external ophthalmoplegia.
authors.affiliation: Emory Eye Center, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Sorkin
authors.forename: J M
authors.initials: JM
authors.lastname: Shoffner
authors.forename: H E
authors.initials: HE
authors.lastname: Grossniklaus
authors.forename: A V
authors.initials: AV
authors.lastname: Drack
authors.forename: S R
authors.initials: SR
authors.lastname: Lambert
mesh_terms: D000328:Adult; D002908:Chronic Disease; D004272:DNA, Mitochondrial / Q000235:genetics; D018450:Disease Progression; D005260:Female; D017353:Gene Deletion; D006801:Humans; D008875:Middle Aged; D017240:Mitochondrial Myopathies / Q000209:etiology* / Q000473:pathology; D009886:Ophthalmoplegia / Q000150:complications*; D013285:Strabismus / Q000209:etiology* / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D004272:DNA, Mitochondrial