{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T10:44:17Z","timestamp":1787827457812,"version":"build-2784847793"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,9,19]],"date-time":"2020-09-19T00:00:00Z","timestamp":1600473600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,9,19]],"date-time":"2020-09-19T00:00:00Z","timestamp":1600473600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100012681","name":"Universit\u00e4tsklinikum K\u00f6ln","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100012681","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Graefes Arch Clin Exp Ophthalmol"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>For some patients with complex ocular motility disorders, conventional strabismus surgery is insufficient. Surgery with tendon elongation allows correction of larger angles and maintains a sufficient arc of contact for rectus muscles. This study reports results for tendon elongation with bovine pericardium (Tutopatch\u00ae) in indications other than Graves\u2019 orbitopathy in which it is already widely used.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We reviewed the records of all patients who underwent surgery with Tutopatch\u00ae in our institution. Angles of squint and head postures were analyzed preoperatively, on the first postoperative day, and in the long term (median 9 weeks after the operation). Patients with Graves\u2019 orbitopathy were excluded.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>From 2011 to 2018, the procedures on 58 eyes of 54 patients (35 females, median age 35 years (3\u201375)) met the inclusion criteria. Horizontal rectus muscle surgery (53 eyes) was conducted on patients with residual strabismus (13), Duane\u2019s retraction syndrome with eso- (type I: 16)\/exodeviation (type II: 2, type III: 1), 6th (7)\/3rd nerve palsy (7), M\u00f6bius syndrome (2), congenital fibrosis of the extraocular muscles type 3A (CFEOM3A, TUBB3 mutation) (4), and orbital apex syndrome (1). Vertical rectus muscle surgery (5 eyes) was conducted on patients with myasthenia (1), vertical tropia after orbital floor fracture (1), CFEOM1 (2), and Parry-Romberg syndrome (1). 42 eyes had prior eye muscle surgery (1\u20135 procedures, median 1). Out of 45 patients with postoperative long-term data, 43 showed an angle reduction. Fifty-one percent had an angle of 10\u0394 (prism diopter) or less, one had a significant over-effect, and 10 had revision surgery. For the heterogeneous group of residual eso- and exotropias, the median absolute horizontal angle was reduced from 35\u0394 (16 to 45\u0394) to 9\u0394 (0 to 40\u0394), for Duane\u2019s retraction syndrome from 27.5\u0394 (9 to 40\u0394) to 7\u0394 (0 to 40\u0394), and for sixth and third nerve palsies from 43\u0394 (20 to 75\u0394) to 18\u0394 (4 to 40\u0394). For 3 patients with vertical rectus muscle surgery, the median absolute vertical angle was reduced from 30\u0394 (20 to 45\u0394) to 4\u0394 (1 to 22\u0394). The motility range was shifted in the direction contrary to the elongated muscle in all subgroups. A considerable reduction of the excursion into the field of action of the elongated muscle had to be registered.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Strabismus surgery with bovine pericardium introduces new surgical options for complicated revisions and for rare and complex oculomotor dysfunctions. Yet, it has to be recognized that this type of surgery aiming at maximum effects, despite preservation or restitution of the arc of contact, leads to reduction of the excursion into the field of action of the elongated muscle. Furthermore, dose finding can be difficult depending on the underlying pathology and more than one intervention might be necessary for optimal results.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00417-020-04939-7","type":"journal-article","created":{"date-parts":[[2020,9,19]],"date-time":"2020-09-19T12:02:48Z","timestamp":1600516968000},"page":"145-155","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Tendon elongation with bovine pericardium in strabismus surgery\u2014indications beyond Graves\u2019 orbitopathy"],"prefix":"10.1007","volume":"259","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6398-3919","authenticated-orcid":false,"given":"Andrea","family":"Hedergott","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ursula","family":"Pink-Theofylaktopoulos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antje","family":"Neugebauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Fricke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,9,19]]},"reference":[{"issue":"4","key":"4939_CR1","doi-asserted-by":"publisher","first-page":"561","DOI":"10.1016\/j.avsg.2010.11.007","volume":"25","author":"X Li","year":"2011","unstructured":"Li X, Guo Y, Ziegler KR, Model LS, Eghbalieh SD, Brenes RA, Kim ST, Shu C, Dardik A (2011) Current usage and future directions for the bovine pericardial patch. 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Throughout the whole study, the Declaration of Helsinki and applicable national regulations and laws were observed.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Not applicable","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Not applicable","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Via corresponding author","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Code availability"}}]}}