Nasal Transposition of the Split Lateral Rectus Muscle for Strabismus Associated with Bilateral 3
rd-Nerve Palsy.
Am J Ophthalmol 2022;
242:165-172. [PMID:
35750218 DOI:
10.1016/j.ajo.2022.06.010]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/08/2022] [Accepted: 06/13/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE
To determine success rate and complications associated with nasal transposition of the split lateral rectus muscle (NTSLR) for treating bilateral 3rd-nerve palsy.
DESIGN
Retrospective, interventional case series METHODS: : Setting: International, multicenter registry Study population: All patients with bilateral 3rd-nerve palsy treated with NTSLR.
OBSERVATION
Sensorimotor evaluations before and 6-months after unilateral or bilateral NTSLR.
OUTCOME MEASURES
Post-operative horizontal alignment ≤ 15 prism diopters (PD), intraoperative technical difficulties, and vision-threatening complications. The association of patient demographics and surgical technique with each outcome was analyzed using multivariable logistic regression.
RESULTS
Thirty-four patients were included with a median age of 46 years (Interquartile range [IQR], 25-54 years) at surgery. The most common etiologies were ischemic (29%), neoplastic (15%), and congenital (12%). NTSLR performed unilaterally with alternative surgery on the opposite eye (65%) resulted in a median post-operative exotropia of 18 PD (IQR, 7-35 PD), and when performed bilaterally (35%) resulted in post-operative exotropia of 14 PD (IQR, 5-35 PD). Success was achieved in 50% of cases, intra-operative technical difficulties reported in 18%, and vision-threatening complications occurred in 21%. Attachment of the lateral rectus muscle ≥ 10 mm posterior to the medial rectus insertion was associated with increased vision-threatening complications (OR, 9.0; 95% CI, 1.3-99).
CONCLUSIONS
NTSLR can address the large-angle exotropia associated with bilateral 3rd-nerve palsy. Surgeons should be aware that posterior placement of the lateral rectus muscle can increase the risk of vision-threatening complications, particularly serous choroidal effusion.
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