Endoscopically Assisted Strabismus Surgery
Bibliographic record
Abstract
BACKGROUND: Strabismus surgery involving open exploration of the posterior orbit is difficult. Exploration is sometimes avoided by considering alternative procedures (transposition and weakening other muscles). Although the use of endoscopic sinus surgery (ESS) to retrieve medial rectus (MR) muscles lost in the posterior orbit has been described, the use of an endoscopic approach to the posterior orbit in elective strabismus surgery has never been reported. METHODS: A patient with thyroid orbitopathy had severe bilateral restrictive strabismus with bilateral esohypotropia, rendering him functionally blind. The MR was inaccessible via the anterior approach. We describe a transnasal endoscopic approach to the posterior orbit where the MR was identified, sectioned, and reattached to the globe. We also describe two other patients who had endoscopic posterior orbit exploration after ESS-related MR injury. RESULTS: In patient 1, repositioning of the medial rectus muscles facilitated follow-up conventional strabismus surgery and dramatically improved ocular alignment. In patient 2, the medial rectus muscle was severely disrupted. A temporary traction suture was placed endoscapically. Follow-up transposition strabimus resulted in satisfactory alignment. In patient 3, endoscopic exploration and freeing of adhesions was done in anticipation of follow-up strabismus surgery. CONCLUSION: These cases illustrate the expanding frontiers of ESS. The endoscopic approach to the posterior orbit allows enhanced posterior orbit access in elective strabismus surgery and posttraumatic exploration of the MR.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".