Worldwide outcomes of nasal transposition of the split lateral rectus muscle for strabismus associated with 3rd-nerve palsy. Issue 5 (8th December 2021)

• Record Type: Journal Article
• Authors: Shah, Ankoor S; Dodd, Mary-Magdalene Ugo; Gokyigit, Birsen; Lorenz, Birgit; Laurent, Erick; Sadiq, Mohammad Ali Ayaz; Tsai, Chong-Bin; Gravier, Nicolas; Goberville, Mitra; Basiakos, Sotirios; Zurakowski, David; Dagi, Linda R
• Other Names: author non-byline.; Agarkar Sumita author non-byline.; Audren Francois author non-byline.; Costa Ana Luiza author non-byline.; de Faber Jan Tjeerd author non-byline.; Elkamshoushy Amr author non-byline.; Friling Ronit author non-byline.; Gräf Michael author non-byline.; Goldchmit Mauro author non-byline.; Heidary Gena author non-byline.; Hunter David author non-byline.; Jeddawi Laila author non-byline.; Karna Madhu author non-byline.; Li Ningdong author non-byline.; Mantagos Iason S author non-byline.; Merino-Sanz Pilar author non-byline.; Orge Faruk author non-byline.; Nirgude Sanket R author non-byline.; Saxena Rohit author non-byline.; Shah Veeral author non-byline.; Sharma Pradeep author non-byline.; Shepherd James Banks author non-byline.; Soni Ajay author non-byline.; Speeg-Schatz Claude author non-byline.; Spielmann Alain author non-byline.; Strominger Mitchell author non-byline.; Sukhija Jaspreet author non-byline.; Velez Federico G author non-byline.; Wygnanski-Jaffe Tamara author non-byline.
• Is Part Of: British journal of ophthalmology. Volume 107:Issue 5(2023)
• Page Start: 725
• Page End: 731
• Publication Date: 2021-12-08
• Subjects: muscles -- treatment surgery; Ophthalmology -- Periodicals; 617.7
• DOI: 10.1136/bjophthalmol-2021-319667
• Languages: English
• ISSNs: 0007-1161

Abstract

Abstract : Background/aims: To determine success rate and complications associated with nasal transposition of the split lateral rectus muscle (NTSLR) for treating strabismus from 3rd-nerve palsy. Methods: An 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. Results: Ninety-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. Conclusion: NTSLR 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.