title: Plication augmentation of the modified Hummelsheim procedure for treatment of large-angle esotropia due to abducens nerve palsy and type 1 Duane syndrome.
abstract: BACKGROUND
  Multiple procedures have been described to treat a large-angle esodeviation with an associated abduction deficit. We report a plication augmentation of the Hummelsheim procedure for the management of esotropia and severe abduction deficit due to abducens nerve palsy or type 1 Duane syndrome.
  
  
  METHODS
  The medical records of patients operated on using the plication augmentation Hummelsheim procedure at two tertiary centers were retrospectively reviewed. The surgery involved ipsilateral lateral rectus plication, half muscle transposition of the vertical rectus muscles to the paralytic plicated lateral rectus, Foster augmentation sutures, and ipsilateral medial rectus recession or botulinum toxin injection if it was found to be tight on intraoperative forced duction testing. Pre- and postoperative deviations, ocular motility findings, and complications were noted.
  
  
  RESULTS
  A total of 13 patients were included, all of whom had an esotropia with profound abduction deficit (-4 or more). Postoperative deviations ranged from 14(Δ) of esotropia to 14(Δ) of exotropia, with significant improvement of the abductive motion. No patient developed anterior segment ischemia.
  
  
  CONCLUSIONS
  The plication augmentation Hummelsheim procedure resulted in correction of even very large esodeviations and improvement of the abduction force. This procedure may also better preserve the blood supply to the anterior segment compared to other surgical approaches.
authors.affiliation: Pediatric Ophthalmology and Adult Re-Alignment Services, Ratner Children's Eye Center at the Shiley Eye Institute, University of California San Diego, California.
authors.forename: Michael
authors.initials: M
authors.lastname: Kinori
authors.affiliation: Pediatric Ophthalmology and Adult Re-Alignment Services, Ratner Children's Eye Center at the Shiley Eye Institute, University of California San Diego, California.
authors.forename: Kyle E
authors.initials: KE
authors.lastname: Miller
authors.affiliation: Department of Ophthalmology, Children's Hospital Medical Center, Akron, Ohio; Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio.
authors.forename: Megan
authors.initials: M
authors.lastname: Cochran
authors.affiliation: Pediatric Ophthalmology and Adult Re-Alignment Services, Ratner Children's Eye Center at the Shiley Eye Institute, University of California San Diego, California.
authors.forename: Preeti A
authors.initials: PA
authors.lastname: Patil
authors.affiliation: Pediatric Ophthalmology and Adult Re-Alignment Services, Ratner Children's Eye Center at the Shiley Eye Institute, University of California San Diego, California.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: El Sahn
authors.affiliation: Pediatric Ophthalmology and Adult Re-Alignment Services, Ratner Children's Eye Center at the Shiley Eye Institute, University of California San Diego, California.
authors.forename: Salma
authors.initials: S
authors.lastname: Khayali
authors.affiliation: Pediatric Ophthalmology and Adult Re-Alignment Services, Ratner Children's Eye Center at the Shiley Eye Institute, University of California San Diego, California.
authors.forename: Shira L
authors.initials: SL
authors.lastname: Robbins
authors.affiliation: Department of Ophthalmology, Children's Hospital Medical Center, Akron, Ohio; SUMMA Medical Center, Akron, Ohio; Northeast Ohio Medical University, Rootstown, Ohio.
authors.forename: Richard W
authors.initials: RW
authors.lastname: Hertle
authors.affiliation: Pediatric Ophthalmology and Adult Re-Alignment Services, Ratner Children's Eye Center at the Shiley Eye Institute, University of California San Diego, California. Electronic address: dgranet@ucsd.edu.
authors.forename: David B
authors.initials: DB
authors.lastname: Granet
mesh_terms: D020434:Abducens Nerve Diseases / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D004370:Duane Retraction Syndrome / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D004948:Esotropia / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D005133:Eye Movements / Q000502:physiology; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage; D009801:Oculomotor Muscles / Q000187:drug effects / Q000503:physiopathology / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures; D012189:Retrospective Studies; D013536:Suture Techniques; D013709:Tendon Transfer; D015348:Vision, Binocular / Q000502:physiology; D055815:Young Adult
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A