Winner of the 2018 Fellow Research Award
Long Term Outcomes of Adjustable Nasal Transposition of Split Lateral Rectus Muscle for Third Nerve Palsy – An International Perspective
Mary-Magdalene U. Dodd, MD; Ankoor Shah, MD, PhD; Jason Mantagos, MD; Birsen Gokyigit, MD, David Hunter, MD, PhD; Linda Dagi, MD
Introduction: The purpose of this study was to report the worldwide experience of strabismus surgeons treating complete third nerve palsy with nasal transposition of the split lateral rectus muscle.
Methods: Pediatric ophthalmologists and strabismologists that have performed at least one nasal transposition of the lateral rectus muscle were invited to participate in a cloud-based survey designed to capture outcomes and complications using this procedure.
Results: Thirty-three patients and 38 eyes with complete third nerve palsy treated with a nasal transposition of the lateral rectus muscle were included in this study. Fifty-one percent of patients were female. Median age was 36.5 (IQR: 19.8, 49.8). Congenital, ischemic and traumatic third nerve palsies were the most common. The median pre-operative deviation was an exotropia measuring 65 prism diopters (IQR: 55, 90). At 6 months the majority of patients were orthotropic at near, by Krimsky. Patients were followed for 26 months (IQR: 10, 32). Final post-op alignment was excellent, measuring within 7 (0, 12.5) prism diopters of orthotropia. There were two reported complications, choroidal effusion (5%) and scleritis (3%).
Discussion: Our cloud-based survey facilitates reporting the international experience with a novel surgical technique for treatment of a rare strabismus problem.
Conclusion: Adjustable nasal transposition of the split lateral rectus provides excellent post-operative Krimsky alignment, long-term stability, and a low risk profile.
References: 1. Kaufmann,H., Lateralissplitting bei totaler Okulomotoriusparalyse mit Trochlearisparese
Fortschr.Ophthalmol. 1991. 88, p. 314-6
2. Shah, A.S., et al., Adjustable nasal transposition of split lateral rectus muscle for third nerve palsy. JAMA Ophthalmol, 2014. 132(8): p. 963-9.