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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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Zhang KX, Varma H, Cao Y, Shah VS. Split-Tendon Medial Transposition of Lateral Rectus for Pediatric Complete Oculomotor Palsy. J Neuroophthalmol 2023; 43:254-260. [PMID: 36342135 PMCID: PMC10166200 DOI: 10.1097/wno.0000000000001731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Split-tendon medial transposition of lateral rectus (STMTLR) for complete oculomotor palsy can correct large angles of exotropia in adults, but outcomes are variable, and complications are frequent. Only a few pediatric cases have been reported, and further insight is needed to assess the child's alignment outcomes and ability for postsurgical gain of function. The aim of our study is to report the outcomes of this surgical procedure in pediatric cases of complete oculomotor palsy. METHODS A retrospective review of outcomes was conducted on 5 consecutive patients with complete oculomotor palsy treated with STMTLR by a single surgeon (V.S.S.) between 2015 and 2021 at tertiary referral centers. Primary outcome was postoperative horizontal alignment, and secondary outcome was demonstration of gain-of-function activity in the field of action of the paretic medial rectus muscle. RESULTS Five cases of pediatric complete oculomotor palsy underwent surgical treatment with STMTLR. Subjects averaged 5.3 years old (range 10 months-16 years). Two were female. Etiologies were heterogeneous, and all presented with unilateral (n = 2) or bilateral complete oculomotor palsy with exodeviations ranging from 45 to >120 prism diopters. Two subjects had bilateral disease secondary to military tuberculosis with CNS involvement. A third subject presented iatrogenically with complete bilateral third nerve palsies secondary to removal of a nongerminomatous germ cell tumor (NGGCT) of the pineal gland. The 2 remaining subjects had monocular involvement in their right eye, 1 from compressive neuropathy after a cavernoma midbrain hemorrhage, and 1 from a congenital right oculomotor palsy. All patients were observed to have stable ocular alignment for a period of at least 6 months before surgery. Unilateral STMTLR was performed in all cases except the subject with NGGCT, in which bilateral STMTLR was performed. Measurement of alignment permanence out to 1-3 years postop resulted in an average correction of 40.83 prism diopters (range 37.5-45 prism diopters) per operated eye. Four of 5 subjects regained limited but active adduction eye movements, and the 2 unilateral cases demonstrated improved convergence. None of the subjects experienced significant complications. CONCLUSIONS STMTLR was a safe and effective approach for the surgical correction of complete pediatric oculomotor palsy in our case series. In addition, pediatric patients may benefit from STMTLR with immediate gain-of-function activity in the transposed lateral rectus muscle, which supports the hypothesis that children have a dynamic and adaptive neuroplasticity of visual target selection that predominates established agonist/antagonist neural signaling.
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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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Shah AS, Dodd MMU, Gokyigit B, Lorenz B, Laurent E, Sadiq MAA, Tsai CB, Gravier N, Goberville M, Basiakos S, Zurakowski D, Dagi LR. Worldwide outcomes of nasal transposition of the split lateral rectus muscle for strabismus associated with 3rd-nerve palsy. Br J Ophthalmol 2021; 107:725-731. [PMID: 34880051 PMCID: PMC10176407 DOI: 10.1136/bjophthalmol-2021-319667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 11/13/2021] [Indexed: 11/03/2022]
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.
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Affiliation(s)
- Ankoor S Shah
- Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, USA.,Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Mary-Magdalene Ugo Dodd
- Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, USA.,Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Birsen Gokyigit
- Pediatric Ophthalmology and Strabismus, Prof Dr N Reşat Belger Beyoglu Education and Research Eye Hospital, Istanbul, Turkey
| | - Birgit Lorenz
- Ophthalmology, Justus-Liebig-University, Universitätsklinikum Gießen und Marburg GmbH, Gießen, Germany
| | - Erick Laurent
- Centre d'Ophtalmologie du Lez, Clinique St Jean, Montpellier, France
| | - Mohammad Ali Ayaz Sadiq
- Institute of Ophthalmology, King Edward Medical University, Lahore, Pakistan.,Institute of Ophthalmology, Mayo Hospital Lahore, Lahore, Pakistan
| | - Chong-Bin Tsai
- Ophthalmology, Chiayi Christian Hospital, Chia-Yi, Taiwan
| | - Nicolas Gravier
- Unité de Strabologie-Polyclinique de l'Atlantique, Nantes-Saint-Herblain Cedex, France
| | | | - Sotirios Basiakos
- Ophthalmology, Justus Liebig Universitat Giessen, Giessen, Germany.,Thessaloniki, Central Macedonia, Greece
| | - David Zurakowski
- Anesthesia, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Linda R Dagi
- Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, USA .,Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
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Khan SS, Shah AS, Dagi LR, Medow NB, Friedman IB, Rosenberg JB. Complication and Management of Optic Nerve Edema Resulting From Nasal Transposition of the Split Lateral Rectus Muscle. J Pediatr Ophthalmol Strabismus 2021; 58:e12-e15. [PMID: 34039163 DOI: 10.3928/01913913-20210216-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 9-year-old boy with partial third nerve palsy underwent medial transposition of the left lateral rectus muscle and left inferior oblique myectomy. He developed optic nerve compression, which improved after a superior oblique tenotomy. A primary superior oblique tenotomy or a maximum lateral rectus muscle split may help avoid this complication. [J Pediatr Ophthalmol Strabismus. 2021;58(3):e12-e15.].
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Splitting of the lateral rectus muscle with medial transposition to treat oculomotor palsy: a retrospective analysis of 29 consecutive cases. Graefes Arch Clin Exp Ophthalmol 2019; 257:2005-2014. [DOI: 10.1007/s00417-019-04370-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/12/2019] [Accepted: 05/20/2019] [Indexed: 10/26/2022] Open
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