title: Function of transected or avulsed rectus muscles following recovery using an anterior orbitotomy approach.
abstract: OBJECTIVE
  To assess the function of muscles retrieved from a retrobulbar location using an anterior orbitotomy approach and to identify the prognostic factors favoring a good outcome.
  
  
  METHODS
  The records of all patients undergoing anterior orbitotomy for the retrieval of a transected or avulsed muscle in a retrobulbar location were reviewed. Ocular motility, before and after retrieval (with ductions scaled from -4 to +4), was evaluated.
  
  
  RESULTS
  Record review identified 11 patients who had suffered trauma to 12 muscles (5 inferior, 6 medial, and 1 lateral rectus muscle). Ductions improved from -4 ± 0.4 preoperatively to -2.7 ± 0.9 postoperatively (P = 0.002); mean primary position deviation improved from 34(Δ) ± 14(Δ)-15(Δ) ± 9(Δ) (P < 0.001), and mean deviation in the field of action improved from 47(Δ) ± 20(Δ)-20(Δ) ± 22(Δ) (P = 0.02). Ductions improved by at least two units in three patients, all of whom had medial rectus trauma. Single binocular vision in primary gaze was achieved in 6 patients. Patients with medial rectus muscle injury and patients injured by sinus surgery had the lowest likelihood of recovering single binocular vision.
  
  
  CONCLUSIONS
  Our results are similar to historical series in which muscles were not retrieved and transpositions performed; however, muscle retrieval avoids risks associated with transposition surgeries such as anterior segment ischemia. Muscle recovery via the anterior orbitotomy approach may be reasonable to consider in those cases with a reasonable possibility of having active force generation postoperatively.
authors: Jules Stein Eye Institute and Department of Ophthalmology, University of California, Los Angeles, California, USA.
authors: Stacy L
authors: SL
authors: Pineles
authors: Jessica
authors: J
authors: Laursen
authors: Robert A
authors: RA
authors: Goldberg
authors: Joseph L
authors: JL
authors: Demer
authors: Federico G
authors: FG
authors: Velez
mesh_terms: D005131:Eye Injuries / Q000209:etiology / Q000601:surgery*; D005133:Eye Movements / Q000502:physiology*; D006801:Humans; D007431:Intraoperative Complications; D008279:Magnetic Resonance Imaging; D015835:Ocular Motility Disorders / Q000209:etiology / Q000503:physiopathology*; D009801:Oculomotor Muscles / Q000293:injuries* / Q000503:physiopathology*; D013508:Ophthalmologic Surgical Procedures; D009915:Orbit / Q000601:surgery*; D009917:Orbital Fractures / Q000209:etiology / Q000601:surgery; D020127:Recovery of Function; D014057:Tomography, X-Ray Computed; D015348:Vision, Binocular / Q000502:physiology