Management of traumatic incomplete lacerating rectus muscle injuries using multimodal imaging approach (ASOCT and CT/MRI)

Abstract

Purpose: To describe the pathophysiology, importance of multimodal imaging approach, and the clinical outcomes of incomplete lacerating rectus muscle injuries. Methods: A retrospective review was conducted to identify patients with ocular deviation secondary to rectus muscle injuries. Between 2019 and 2022, a total of 30 patients were identified, amongst whom eleven patients had incompletely lacerated rectus muscles (secondary to penetrating adnexal trauma and sino-orbital surgeries). Patients' demography, nature of injury, computed tomography/magnetic resonance imaging, anterior segment optical coherence tomography features, intra-operative findings, and post-operative outcomes were reviewed. Results: The mean age of 11 patients was 31.36 ± 14.38 years. All patients had external trauma which severed the muscle in its anterior portion. Five patients had isolated inferior rectus muscle injury (45.45%), three had inferior and medial rectus muscle injuries together (27.27%), two had isolated lateral rectus muscle injury (18.18%), and one remaining patient had isolated medial rectus muscle injury (9.05%). In ten patients (90.90%) CT/MRI revealed features suggestive of muscle injury, however details with respect to muscle insertion and scleral course were lacking. In this difficult scenario, ASOCT filled these lacunae in nearly 90% of the patients by providing surgically useful details. Moreover, when CT/MRI-ASOCT imaging features were combined, the management and outcomes were even more predictable. Conclusions: Penetrating rectus muscle injuries can be better identified as incompletely lacerated muscle using multimodal imaging approach. This simple image correlation process customizes the treatment approach and hence the clinical outcomes.

Keywords: Extraocular muscle injury; incomplete laceration; relaxing or lengthening injuries.