Worldwide outcomes of nasal transposition of the split lateral rectus muscle for strabismus associated with 3rd-nerve palsy

2021 ◽  
pp. bjophthalmol-2021-319667
Author(s):  
Ankoor S Shah ◽  
Mary-Magdalene Ugo Dodd ◽  
Birsen Gokyigit ◽  
Birgit Lorenz ◽  
Erick Laurent ◽  
...  
Keyword(s):  
Success Rate ◽  
Nerve Palsy ◽  
Rectus Muscle ◽  
Strabismus Surgery ◽  
Lateral Rectus ◽  
Oblique Muscle ◽  
Primary Position ◽  
Lateral Rectus Muscle ◽  
Muscle Insertion ◽  
Contralateral Eye

Background/aimsTo determine success rate and complications associated with nasal transposition of the split lateral rectus muscle (NTSLR) for treating strabismus from 3rd-nerve palsy.MethodsAn international, multicentre, registry of patients with unilateral 3rd-nerve palsy treated with NTSLR was created. Patients with concurrent surgery on the contralateral eye were excluded. Primary outcome was horizontal alignment within 15 prism dioptres (PD) of orthotropia. Incidence of technical difficulties and vision-threatening complications by 6 months post-procedure were reported.ResultsNinety-eight patients met inclusion criteria. Median age was 33.5 years (IQR 10.75–46). Aetiologies included congenital (31%), neoplastic (16%) and traumatic (15%). Twenty-five per cent of patients had prior ipsilateral strabismus surgery. Median exotropia decreased from 70PD preoperatively (IQR 50–90) to 1PD postoperatively (IQR 0–15.5), with a success rate of 69%. Performing concurrent superior oblique muscle tenotomy (SOT) was independently associated with success (p=0.001). Technical challenges occurred in 30% of cases, independently associated with a history of ipsilateral strabismus surgery (p=0.01). Eleven per cent of patients had vision-threatening complications, independently associated with more posterior placement of the split lateral rectus (LR) muscle (p<0.001), and most commonly transient serous choroidal effusion. Surgical placement of the split LR muscle within 4.25 mm of the medial rectus (MR) muscle insertion reduced this risk.ConclusionNTSLR significantly improved primary position alignment altered by 3rd-nerve palsy. Concurrent SOT and placement of the split LR muscle ≤4.25 mm posterior to the MR muscle insertion optimised outcomes. NTSLR proved technically challenging when prior ipsilateral strabismus surgery had been performed.

scholarly journals Superior Oblique Anterior Transposition with Horizontal Recti Recession-Resection for Total Third-Nerve Palsy

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Muhsin Eraslan ◽  
Eren Cerman ◽  
Sumru Onal ◽  
Mehdi Suha Ogut
Keyword(s):  
Nerve Palsy ◽  
Rectus Muscle ◽  
Lateral Rectus ◽  
Medial Rectus ◽  
Oblique Muscle ◽  
Primary Position ◽  
Vertical Deviation ◽  
Third Nerve Palsy ◽  
Third Nerve ◽  
Superior Oblique

Aims. To report the results of lateral rectus muscle recession, medial rectus muscle resection, and superior oblique muscle transposition in the restoration and maintenance of ocular alignment in primary position for patients with total third-nerve palsy.Methods. The medical records of patients who underwent surgery between March 2007 and September 2011 for total third-nerve palsy were reviewed. All patients underwent a preoperative assessment, including a detailed ophthalmologic examination.Results. A total of 6 patients (age range, 14–45 years) were included. The median preoperative horizontal deviation was 67.5 Prism Diopter (PD) (interquartile range [IQR] 57.5–70) and vertical deviation was 13.5 PD (IQR 10–20). The median postoperative horizontal residual exodeviation was 8.0 PD (IQR 1–16), and the vertical deviation was 0 PD (IQR 0–4). The median correction of hypotropia following superior oblique transposition was 13.5 ± 2.9 PD (range, 10–16). All cases were vertically aligned within 5 PD. Four of the six cases were aligned within 10 PD of the horizontal deviation. Adduction and head posture were improved in all patients. All patients gained new area of binocular single vision in the primary position after the operation.Conclusion. Lateral rectus recession, medial rectus resection, and superior oblique transposition may be used to achieve satisfactory cosmetic and functional results in total third-nerve palsy.

Augmented vertical rectus transpositions: Intraoperative measurement of torsion following sequential muscle detachment

2020 ◽  
pp. 112067212094656
Author(s):  
Massimiliano Serafino ◽  
Matteo Scaramuzzi ◽  
Adriano Magli ◽  
Paolo Nucci
Keyword(s):  
Adverse Effects ◽  
Monitoring System ◽  
Intraoperative Monitoring ◽  
Nerve Palsy ◽  
Rectus Muscle ◽  
Lateral Rectus ◽  
Inferior Rectus ◽  
Complete Transposition ◽  
Lateral Rectus Muscle ◽  
Sixth Nerve

Introduction: After vertical recti transposition surgery, a torsional change may occur. We hypothesized that step-by-step monitoring of the intraoperative torsional position of the eye can avoid any unexpected complications and identify critical moments of surgery that may have adverse effects. Methods: Nine patients with sixth nerve palsy that underwent complete transposition of the superior (SR) and inferior rectus (IR) muscles to the lateral rectus muscle by means of the technique of augmented vertical recti transposition were prospectively included. The torsional position of the eye was recorded at eight stages of the procedure. Results: We observed two distinct patterns of induced torsional deviation during partial disinsertion of a vertical rectus muscle depending on whether disinsertion began medially or laterally, after cutting about 3/4 of the muscle fibers: ¾ nasal disinsertion of the SR and ¾ temporal disinserton of the IR caused intorsion, ¾ temporal disinsertion of the SR and ¾ nasal disinsertion of the IR caused extorsion. Torsion improved after the vertical rectus was attached temporally to the sclera along the spiral of Tillaux with tying of the augmentation suture to the LR. The greatest change in torsion was from ¾ temporal disinsertion of the SR (5°extorsion), to reattachment along the spiral of Tillaux temporally (5°intorsion). Conclusion: The SR and IR have different torsional effects, which only appears when more than half of the fibers are detached. Augmented transposition does not cause any additional torsional effects. This intraoperative monitoring system can be used to detect unintended torsional complications, especially during transposition surgery.

scholarly journals Therapeutic results in sixth nerve palsy

2015 ◽  
Vol 22 (1) ◽  
pp. 51-59
Author(s):  
Violeta-Ioana Pruna ◽  
Daniela Cioplean ◽  
Liliana Mary Voinea
Keyword(s):  
Nerve Palsy ◽  
Rectus Muscle ◽  
Lateral Rectus ◽  
Medial Rectus ◽  
Therapeutic Success ◽  
Primary Position ◽  
Sixth Nerve Palsy ◽  
Single Vision ◽  
Binocular Single Vision ◽  
Sixth Nerve

Abstract Authors aim to assess through a retrospective study the efficiency of different therapeutic methods used in VIth nerve palsy. 60 patients with VIth nerve palsy, admitted and treated in Oftapro Clinic, were divided into two groups: a group with partial dysfunction (paresis) of sixth nerve and a group with the complete abolition of neuromuscular function (VIth nerve palsy). Initial examination included assessment of neuromuscular function, binocular vision and existence of medial rectus muscle contracture (ipsi- and contralateral) and contralateral lateral rectus inhibitory palsy. Neuromuscular dysfunction was graded from - 8 (paralysis) to 0 (normal abduction). Therapeutic modalities ranged from conservative treatment (occlusion, prism correction), botulinum toxin chemodenervation and surgical treatment: medial rectus recession + lateral rectus resection, in cases of paresis, and transposition procedures (Hummelscheim and full tendon transfer) in cases of sixth nerve palsy. Functional therapeutic success was defined as absence of diplopia in primary position, with or without prism correction, and surgical success was considered obtaining orthoptic alignment in primary position or a small residual deviation (under 10 PD). 51 patients had unilateral dysfunction, and 9 patients had bilateral VI-th nerve dysfunction. 8 patients had associated fourth or seventh cranial nerves palsy. The most common etiology was traumatic, followed by tumor and vascular causes. There were 18 cases of spontaneous remission, partial or complete (4-8 months after the onset), and 6 cases enhanced by botulinum toxin chemodenervation. 17 paretic eyes underwent surgery, showing a very good outcome, with restoration of binocular single vision. The procedure of choice was recession of medial rectus muscle, combined with resection of lateral rectus muscle. All patients with sixth nerve palsy underwent surgery, except one old female patient, who refused surgery. Hummelscheim procedure was applied in 19 cases, and full tendon transfer in 6 cases. In 13 cases partial results were obtained, who needed further prismatic correction or reintervention. In 12 cases the outcome was very good, with restoration of binocular single vision, without prismatic correction. Therapeutic success in sixth nerve palsy depends on accurate assessment of neuromuscular dysfunction and appropriate choice of therapeutic modality for each case. Interdisciplinary collaboration is mandatory for correct etiologic diagnosis of sixth nerve palsy.

Sign in / Sign up

Export Citation Format

Share Document