Name of the Procedure:

Transposition procedure (e.g., for paretic extraocular muscle), any extraocular muscle (specify).

Summary

A transposition procedure is eye surgery that involves repositioning one or more of the eye muscles to correct movement problems typically resulting from a weakened or paralyzed muscle. This helps the eyes align properly and work together.

Purpose

The procedure is used to address misalignment of the eyes due to weakened or paralyzed extraocular muscles. The goal is to improve eye coordination and alignment, enhancing both appearance and functional vision.

Indications

• Strabismus (crossed eyes) due to paralytic causes
• Incomplete or complete paralysis of one or more extraocular muscles
• Diplopia (double vision) caused by muscle weakness
• Patients who have not responded to other treatments such as glasses or non-surgical measures

Preparation

• Fasting may be required if general anesthesia will be used.
• Certain medications might need to be adjusted or discontinued.
• Pre-operative tests such as blood work or imaging studies may be necessary to plan the surgery.

Procedure Description

1. The patient is given anesthesia (local or general depending on the case).
2. A small incision is made in the conjunctiva, the membrane covering the white part of the eye.
3. The targeted extraocular muscle is located and carefully detached from its original insertion point.
4. The muscle is then repositioned and reattached at a new location to alter its pulling force on the eye.
5. The incision is sutured closed. Tools used include surgical forceps, sutures, and sometimes specialized instruments for manipulating delicate eye muscles.

Duration

The procedure typically takes about 1 to 2 hours, depending on the complexity and number of muscles involved.

Setting

The procedure is usually performed in a hospital or an outpatient surgical center.

Personnel

• Ophthalmologist or specialized eye surgeon
• Anesthesiologist
• Surgical nurses and possibly technicians

Risks and Complications

• Infection
• Bleeding
• Overcorrection or undercorrection requiring additional surgeries
• Diplopia (double vision) persisting or arising
• Anesthesia-related risks

Benefits

• Improved eye alignment
• Better binocular vision
• Reduction or elimination of double vision
• Enhanced aesthetic appearance of the eyes Improvement might be noticed shortly after the procedure or over a few weeks as healing progresses.

Recovery

• Patients may experience some discomfort or mild pain, managed with prescribed medications.
• Use of eye drops or ointments to prevent infection and aid healing.
• Avoiding strenuous activities and following up with the surgeon as instructed.
• Full recovery is typically within a few weeks to a few months, during which vision improves gradually.

Alternatives

• Prism glasses to address double vision.
• Botulinum toxin injections to temporarily reduce muscle imbalances.
• Non-surgical exercises or visual therapy, though less effective for severe cases. Each alternative has its limitations; surgical options tend to offer more permanent solutions.

Patient Experience

• During the procedure, the patient will often be unaware if under general anesthesia, or might feel minimal discomfort with local anesthesia.
• Post-procedure, there may be temporary discomfort, redness, and swelling.
• Pain management includes prescribed pain relief and anti-inflammatory medications.
• Patients can usually return to normal activities within a few days, with some vision restrictions as advised by the surgeon.

Pain and discomfort should decrease gradually as the eye heals, leading to improved eye alignment and vision.