Uploaded bySAID JAMALEDDINE
New technique for squint surgery (myectomy non suture technique)
This document presents a new myectomy technique for horizontal squint surgery, aimed at addressing the high rates of over or under-correction associated with traditional methods. The technique is characterized by simplicity, efficiency, less time required, and fewer side effects, with evidence of improved eye alignment and motility in a variety of patients. Clinical observations indicate a significant cosmetic and functional improvement, with similar effectiveness to conventional methods but with fewer complications.
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New technique for squint surgery (myectomy non suture technique)
- 2. Myectomy Technique for HorizontalSquint Surgery Dr.Said JamalEddin M.D. KSA dr.jamal19@gmail.com -Co-Authors: Abdulkader JamalEddin M.D. Giasuddin Ahmad M.D. -Victor Babes University of Medicine and Pharmacy, Timisoara, Romania. -Baish General Hospital, Jazan, KSA. By:
- 3. AIM To go beyondthe common and explain a new surgical technique in strabismus surgery, discuss it and compare it with the old Conventional ones. dr.jamal19@gmail.com
- 4. There are somerules need to be discussed, such as: ▪ squint surgical rules . ▪ Terms of ocular Movements: ▪ -ANTOGISNT –AGONIST -YOKE MUSCLE -SYNERGIST ▪ Laws of ocular mobility: ▪ SHERRINGTON LAW: reciprocal innervations ▪ HERRING LAW: equal innervations dr.jamal19@gmail.com
- 5. The classical surgicalsquint techniques mostly depend on: changing the mechanical action of the muscles by resections or recessions. and such rules explain the movement of the eye. I suppose there is also compass like center at the eye ball . OR The ocular muscles itself has a control center like the heart muscle P.M. OR there is neurological control (supranuclear) of the ocular muscles. dr.jamal19@gmail.com
- 6. Background How did Istarted with this technique ? • Due to the high rate of over or under-correction and reoperation surgeries with unpredictable result (15- 35 % ). • I observed ten cases of adjustable suture during first week of surgery, and I found that the eye motility and alignment is VERY GOOD and it doesn't need adjustment. • Depending on myectomy of inferior oblique… dr.jamal19@gmail.com
- 7. • What’s aboutthe rules that I found? -four rules: evaluation during operation after every step of surgery… Myectomy on insertion or 1mm or 2mm from insertion… More dissection for high squint degree… Tractional suture for high squint degrees…
- 8. “there has beensteady increase in knowledge of the supranuclear pathway that control eye movements including the pathway in the brainstem and cerebellum and their connection. ( Step by Step® Squint Surgery ) By Prasad Walimbe-2011 dr.jamal19@gmail.com Support Note
- 9. So what aboutmy technique.. • is a new revolution in our ophthalmic field because: ▪ it is simpler ▪ easier to do ▪ require less time. ▪ no need of suturing. ▪ small incision. ▪ local anesthesia (drop and subconjunctival lidocaine injection 1% or 2%) except for children under 12 years old. ▪ no side-effects with more efficient results. dr.jamal19@gmail.com
- 10. • I haveoperated about 74 primary squint patients (XT-ET and some secondary cases – re-operated) 34 of them preformed in Baish General hospital, KSA and the rest in Libya. • Different age group 6y– 70y. • the observations of their results after using this New technique for one year, two years and three years. So what about my technique.. dr.jamal19@gmail.com
- 11. After I doa myectomy to recess for medial rectus or lateral rectus and leave it as it is, There is no need to reinsert the muscles, because the eye will balance directly during operation, and the muscle will adjust and reinsert by itself soon as the eye motility require. no need to adjustable suture. dr.jamal19@gmail.com The result is:
- 12. Discussion No. of Cases Type of Strabismus Degreeof Refraction Muscle Myectomy Distance of Resection 9 Esotropia < 20˚ Between (+0.5 ~ +3) 5 cases OU Medial rectus Myectomy 4 cases one eye Medial rectus myectomy Over insertion 11 Esotropia of 35˚ (Plano ~ +1) OU Medial rectus myectomy 1mm from insertion 10 Esotropia > 45˚ (+1 ~ +2) OU Medial rectus myectomy 2mm from insertion Dissection in all 5 cases with Traction sutures
- 13. Discussion No. of CasesType of Strabismus Degree of Refraction Muscle Myectomy Distance of Resection 15 Exotropia of 50˚ (-1 ~ -4) OU lateral rectus myectomy 2mm from insertion - 5 Residual paralysis of the VI nerve of 60˚ (-1 ~ -4) with Amblyopia OU lateral rectus myectomy 2mm from insertion. With Traction suture 4 Partial paralysis of VI nerve of 55˚ - OU medial rectus Myectomoy 2 mm from the insertion for the muscle which is more paralyzed and 1 mm for the other Dissection in all cases
- 14. Discussion No. of Cases Type of Strabismus Degreeof Refraction Muscle Myectomy Distance of Resection 6 Residual right exotropia 50˚ (-2) with amblyopia OU medial rectus Myectomy 2mm from the insertion for one muscle 2 cases with traction sutures 4* Consecutive exotropia with anisometropia of 55˚ greater to the left eye Between (-9 OS~ OD-2) OU lateral rectus myectomy 2mm from the insertion 1 case with traction sutures
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- 19. CT images Foundthat ocular muscles after operation will very soon insert to the sclera in new place and adjust by it self. and the eye will balance also. dr.jamal19@gmail.com
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- 29. • the cosmeticimprovement is (85 -95%). • the binocular vision is improved in young children 45%??. • all the patients showed improvement, and no permanent double vision. Conclusion dr.jamal19@gmail.com
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- 31. dr.jamal19@gmail.com العيون وتجميل الحولجراحة مركز Squint Surgery Center
- 32. Homs-2011 مسجدالصحابيخالدابنالوليد حمصـسوريا Thank you foryour attention and feel free for further discussion. dr.jamal19@gmail.com
- 33. العيون وتجميل الحولجراحة مركزSquint Surgery Center Homs 2016