Fascia Lata Augmented Nasal Transposition of Split Lateral Rectus for Reoperation of Complete Third Nerve Palsy
Chong-Bin Tsai MD, PhD
Department of Ophthalmology, Chiayi Christian Hospital
Chiayi City, Taiwan
Introduction: Complete third nerve palsy causes incomitant strabismus. Traditional recession and resection procedures often yield limited outcome. Nasal transposition of split lateral rectus were reported to correct the deviation successfully. However, this procedure was mainly recommended in primary cases, with concerns of lateral rectus contracture and extensive scarring in re-operative cases. Therefore, we developed a technique of fascia lata augmentation for split lateral rectus for nasal transposition in re-operative cases.
Methods: The posterior edge of adhesion of previously operated lateral rectus was evaluated with magnetic resonance imaging. The lateral rectus was carefully identified and isolated. Fascia lata autografts were used to augment split lateral rectus for nasal transposition. The augmented split halves were then transposed and reattached at the borders of medial rectus.
Results: Two cases successfully underwent the procedure. One case had prior surgery of recession and resection. The other case had several prior surgeries, including recession and resection, posterior lateral tendon fixation, and globe fixation with medial periosteal flap. The procedure resulted satisfactory results in both cases.
Discussion: Extensive fibrosis and adhesion were the major challenge of this technique in re-operative cases. Pre-operative image study could help to locate the displaced lateral rectus. The muscles were often fragile and should be manipulated cautiously.
Conclusion: With careful preoperative evaluation and meticulous surgical manipulation, fascia lata augmented nasal transposition of split lateral rectus might be an option of rescue for re-operative cases of complete third nerve palsy.
References: 1.Gokyigit, B., et al., Medial transposition of a split lateral rectus muscle for complete oculomotor nerve palsy. J AAPOS, 2013. 17(4): p. 402-10.
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.