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Background In motility disorders related to Graves' orbitopathy, recession of fibrotic eye muscles is the treatment of choice. Correction of very large squint angles can be difficult, since the distance of recession is limited by the necessity to maintain a sufficient arc of contact. A new technique of tendon elongation has been developed in order to maintain sufficient arcs of contact even in patients with large horizontal squint angles, especially after orbital decompression surgery. The established dose-effect relationship cannot simply be conveyed to inferior rectus muscle surgery, due to a different impact of simple recession on inferior and medial rectus muscles. Methods Recession of the inferior rectus muscle was performed in 10 patients with simultaneous suturing of bovine pericardium (Tutopatch). This procedure was performed as primary surgery in 7 patients (2 after orbital decompression) and as secondary procedure in 3 patients. Squint angle (far distance), bulbus excursion movements and field of binocular single vision were evaluated pre- and postoperatively. Results Alignment (far distance) was achieved in 8 of 10 cases at the final follow-up examination. Two patients required corrective prisms. Visual fields were virtually free of diplopia in all patients. The dose-response effect for tendon elongation of the inferior rectus muscle was identical to that for the simple recession of this muscle. There were no complications. Conclusions The new technique of tendon elongation using a bovine pericardium graft is applicable in large vertical squint angles (with or without prior bony orbital decompression) as well as for corrections after insufficient simple recessions (by realignment of the muscle and secondary suturing of the graft). Functional improvement can thus be achieved through surgery of a single muscle, keeping the other muscles in reserve for further interventions (lowering the risk of postoperative anterior segment ischaemia). There is a dose effect analogous to large horizontal squint angles in Graves' orbitopathy (dosing formula: 1 mm inferior rectus recession [including graft] leads to 2.0° vertical angle reduction). This corresponds to simple recessions of the inferior rectus muscle but differs from tendon elongations of the medial rectus muscles.

BACKGROUND: Basal ganglia diseases with an akinetic-rigid symptom manifest like a Parkinson disease or an atypical Parkinson syndrome. Their symptoms are similar and therefore a diagnosis often is only possible after long-standing care of the patient. In the class of the atypical Parkinson syndromes is the progressive supranuclear palsy (PSP), which is also known as Steele-Richardson-Olszewski syndrome. CASE REPORT: A seventy-year-old patient who reported unaccountable sudden drops and disturbances of balance as well as diplopia in near vision was examined and a retrospective analysis of the case history was carried out. RESULTS: Only long-standing observation of the patient rendered the suspected diagnosis of a progressive supranuclear palsy (PSP) possible. Only after determination of the clinic picture of a vertical palsy to the up and the down direction and a bad optokinetic nystagmus with an existing vertical vestibular reflex could the clinical diagnosis of PSP be confirmed. CONCLUSION: In cases with the combination of a vertical palsy, an akinetic-rigid Parkinson syndrome, pyramidal tract signs and subcortical dementia, the diagnosis of a suspected progressive supranuclear palsy should be made. L-Dopa medication has very little or no influence on PSP. At present, however, a certain diagnosis is only possible post-mortem, in spite of helpful clinical diagnostics.