title: Classification and surgical management of patients with familial and sporadic forms of congenital fibrosis of the extraocular muscles.
abstract: OBJECTIVE
  To outline the clinical features and surgical treatment of patients with familial and sporadic (simplex) forms of congenital fibrosis of extraocular muscles (CFEOM) from 2 countries, and to classify them according to phenotype and mode of inheritance.
  
  
  METHODS
  Observational and experimental study.
  
  
  METHODS
  Twenty-eight affected individuals from 20 families with familial or sporadic CFEOM underwent assessment of ocular motility, visual acuity, slit-lamp biomicroscopy, tonometry, and ophthalmoscopy. Seventeen patients had a variety of eye muscle procedures and ptosis repair.
  
  
  RESULTS
  There were 1 Iranian family with autosomal dominant CFEOM, 4 Iranian families with autosomal recessive disease, and 15 simplex cases with various CFEOM phenotypes. Two simplex patients had unilateral disease. All other cases were bilateral. Inferior rectus recession improved hypotropia and Bell's phenomenon in the patients with infraducted eyes and chin elevation. Horizontal muscle recession, sometimes combined with opposite muscle resection, corrected horizontal strabismus satisfactorily in most cases. Ptosis was repaired by frontalis sling and/or levator resection.
  
  
  CONCLUSIONS
  Definite recessive CFEOM was present only in Iranian patients. American patients had the classic phenotype of dominant CFEOM, which was also observed in some of the Iranian patients. The surgical management of patients with CFEOM is challenging. Correction of vertical and horizontal strabismus was addressed using large muscle recessions. Ptosis repair should aim at placing the lid level 1 to 2 mm above the pupil in the primary position to avoid exposure keratopathy.
authors.affiliation: Department of Pediatric Ophthalmology and Strabismus and Center for Genetic Eye Diseases, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Yazdani
authors.forename: Elias I
authors.initials: EI
authors.lastname: Traboulsi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001763:Blepharoptosis / Q000175:diagnosis / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005133:Eye Movements; D005260:Female; D005355:Fibrosis / Q000151:congenital; D006801:Humans; D008297:Male; D008365:Manometry; D009801:Oculomotor Muscles / Q000473:pathology* / Q000601:surgery; D009886:Ophthalmoplegia / Q000145:classification* / Q000235:genetics / Q000601:surgery*; D010641:Phenotype; D014792:Visual Acuity