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Oke I, Lorenz B, Basiakos S, Gokyigit B, Dodd MMU, Laurent E, Sadiq MA, Goberville M, Elkamshoushy A, Tsai CB, Gravier N, Speeg-Schatz C, Shepherd JB, Saxena R, Soni A, Hunter DG, Shah AS, Dagi LR. Extraocular muscle ductions following nasal transposition of the split lateral rectus muscle. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023; 58:565-569. [PMID: 36372135 DOI: 10.1016/j.jcjo.2022.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 10/22/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To quantify changes in ductions following nasal transposition of the split lateral rectus muscle (NTSLR) for treating third nerve palsy. DESIGN Retrospective cohort study. PARTICIPANTS A single eye from each patient with third nerve palsy treated with NTSLR with ocular motility measurements. METHODS Observation of changes in pre- and postoperative ductions. Outcome measures including patient demographic and surgical factors associated with the ability to adduct beyond the midline after NTSLR were evaluated using multivariable logistic regression. RESULTS A total of 116 patients met the inclusion criteria for this study. The NTSLR significantly decreased abduction (median of 0 limitation [interquartile range (IQR), 0-0] prior to surgery to -4 [IQR, -4 to -3] after NTSLR; p < 0.001), with a corresponding improvement in adduction (median, -5 [IQR, -5 to -4] prior to surgery to -4 [IQR, -4 to -3] after NTSLR; p < 0.001). There was no change in median supraduction or infraduction after NTSLR (p > 0.05). The ability to adduct beyond the midline after NTSLR was demonstrated in 42% of patients. Although not statistically significant, a trend toward a postoperative ability to adduct beyond the midline was seen in patients who had concurrent superior oblique muscle tenotomy (odds ratio [OR] = 5.08; 95% CI, 0.91-40.9) or who were designated with partial rather than complete third nerve palsy (OR = 2.29; 95% CI, 0.82-6.70). CONCLUSIONS NTSLR improves the horizontal midline positioning of eyes with third nerve palsy. Most eyes lose the ability to abduct, but some regain a modest ability to adduct while vertical ductions remain unchanged.
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Affiliation(s)
- Isdin Oke
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Birgit Lorenz
- Department of Ophthalmology, Justus Liebig University Giessen, Universitaetsklinikum Giessen and Marburg GmbH, Giessen Campus, Giessen, Germany
| | - Sotirios Basiakos
- Department of Ophthalmology, Justus Liebig University Giessen, Universitaetsklinikum Giessen and Marburg GmbH, Giessen Campus, Giessen, Germany
| | - Birsen Gokyigit
- Pediatric Ophthalmology and Strabismus Department, Prof. Dr. N. Reşat Belger Beyoglu Education and Research Eye Hospital, Istanbul, Turkey
| | - Mary-Magdalene Ugo Dodd
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Erick Laurent
- Centre d'Ophtalmologie du Lez et Clinique St. Jean, Montpellier, France
| | - Mohammad Ali Sadiq
- Institute of Ophthalmology, King Edward Medical University, Mayo Hospital, Lahore, Pakistan
| | | | - Amr Elkamshoushy
- Department of Ophthalmology, University of Alexandria, Alexandria, Egypt
| | - Chong-Bin Tsai
- Department of Ophthalmology, Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Nicholas Gravier
- Unité de Strabologie-Polyclinique de l'Atlantique, Nantes-Saint-Herblain Cedex, France
| | | | | | - Rohit Saxena
- Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | | | - David G Hunter
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Ankoor S Shah
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Linda R Dagi
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, MA.
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Oke I, Lorenz B, Basiakos S, Gokyigit B, Laurent E, Tsai CB, Orge F, Heidary G, Tjeerd de Faber J, Jeddawi L, Sadiq MA, Strominger M, Dodd MMU, Shah AS, Dagi LR. Aberrant regeneration in an international registry of patients with 3rd-nerve palsy. Eur J Ophthalmol 2023; 33:2154-2161. [PMID: 37265190 DOI: 10.1177/11206721231161377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
BACKGROUND/AIMS To describe the patterns of pre-operative aberrant regeneration and motility outcomes reported in an international registry of patients with 3rd-nerve palsy treated with nasal transposition of the split lateral rectus muscle (NTSLR). METHODS This cross-sectional study used data from an international, multicentre registry of patients with 3rd-nerve palsy treated with NTSLR. Patients with aberrant regeneration were identified, and patterns of innervation described. Demographics and postoperative success defined as horizontal alignment ≤15 PD were compared based on the presence, and type, of aberrant regeneration using Wilcoxon rank sum and Fisher's exact tests. RESULTS Aberrant regeneration was reported in 16% (21/129) of patients. Age at diagnosis, sex, and aetiology of palsy were not significantly associated with aberrant regeneration. Abnormal movements were triggered by adduction in 52% (11/21), infraduction in 23% (5/21), and supraduction in 23% (5/21) of cases. Presentation patterns involved rectus muscle innervation in 29% (6/21) and levator muscle innervation in 71% (15/21) of cases. Although patients with aberrant regeneration had similar probability of success in comparison to those without following NTLSR (76% vs. 69%, p = 0.5), those with abnormal innervation of a rectus muscle had a lower success rate than those with abnormal innervation of the levator palpebrae superioris muscle (17% vs. 93%; p = 0.002). CONCLUSION Successful treatment of a 3rd nerve palsy with NTSLR was not influenced by aberrant regeneration involving the levator muscle. Alternative surgical interventions should be considered when aberrant regeneration alters rectus muscle function given its adverse impact on motor outcomes with NTSLR.
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Affiliation(s)
- Isdin Oke
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Birgit Lorenz
- Department of Ophthalmology, Justus Liebig University Giessen, Universitaetsklinikum Giessen and Marburg GmbH, Giessen, Germany
| | - Sotirios Basiakos
- Department of Ophthalmology, Justus Liebig University Giessen, Universitaetsklinikum Giessen and Marburg GmbH, Giessen, Germany
| | - Birsen Gokyigit
- Pediatric Ophthalmology and Strabismus Department, Prof Dr N Reşat Belger Beyoglu Education and Research Eye Hospital, Istanbul, Turkey
| | - Erick Laurent
- Centre d'Ophtalmologie du Lez et Clinique St Jean, Montpellier, France
| | - Chong-Bin Tsai
- Department of Ophthalmology, Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Faruk Orge
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Gena Heidary
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Laila Jeddawi
- Pediatric Ophthalmology Division, Dhahran Eye Specialist Hospital, Dhahran, Saudi Arabia
| | - Mohammad Ali Sadiq
- Institute of Ophthalmology, King Edward Medical University, Mayo Hospital, Lahore, Pakistan
| | - Mitchell Strominger
- Department of Ophthalmology, University of Nevada Reno School of Medicine, Renown Medical Center, Reno, NV, USA
| | - Mary-Magdalene Ugo Dodd
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Ankoor S Shah
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Linda R Dagi
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
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Gräf M, Starosta DA, Hausmann A. [Rehabilitative surgery for oculomotor nerve palsy]. DIE OPHTHALMOLOGIE 2023; 120:1049-1052. [PMID: 36725740 DOI: 10.1007/s00347-023-01807-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/24/2022] [Accepted: 01/02/2023] [Indexed: 02/03/2023]
Affiliation(s)
- Michael Gräf
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Friedrichstr. 18, 35385, Gießen, Deutschland.
- Fachbereich Humanmedizin, Justus-Liebig-Universität Gießen, Gießen, Deutschland.
| | - Daniela A Starosta
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Friedrichstr. 18, 35385, Gießen, Deutschland
| | - Anja Hausmann
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Friedrichstr. 18, 35385, Gießen, Deutschland
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Yahalom C, Hunter DG, Dagi LR. Strategies for managing strabismus from oculomotor nerve palsy. J AAPOS 2023; 27:3-9. [PMID: 36640897 DOI: 10.1016/j.jaapos.2022.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/25/2022] [Accepted: 11/02/2022] [Indexed: 01/13/2023]
Abstract
Addressing ocular misalignment secondary to partial and complete oculomotor nerve palsy presents a special challenge to the strabismus surgeon, particularly when treating patients with binocular diplopia. We review the reported surgical options and, through illustrative cases, provide our own perspective on managing this disorder.
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Affiliation(s)
- Claudia Yahalom
- Department of Ophthalmology, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - David G Hunter
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Linda R Dagi
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
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