Advertisement

Extraocular muscle ductions following nasal transposition of the split lateral rectus muscle

Published:November 10, 2022DOI:https://doi.org/10.1016/j.jcjo.2022.10.019

      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 NRSLR (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.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Canadian Journal of Ophthalmology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Taylor JN.
        Surgical management of oculomotor nerve palsy with lateral rectus transplantation to the medial side of globe.
        Aust N Z J Ophthalmol. 1989; 17: 27-31
        • Kaufmann H.
        [“Lateralis splitting” in total oculomotor paralysis with trochlear nerve paralysis].
        Fortschr Ophthalmol. 1991; 88: 314-316
        • Gokyigit B
        • Akar S
        • Satana B
        • Demirok A
        • Yilmaz OF.
        Medial transposition of a split lateral rectus muscle for complete oculomotor nerve palsy.
        J AAPOS. 2013; 17: 402-410
        • Shah AS
        • Prabhu SP
        • Sadiq MAA
        • Mantagos IS
        • Hunter DG
        • Dagi LR.
        Adjustable nasal transposition of split lateral rectus muscle for third nerve palsy.
        JAMA Ophthalmol. 2014; 132: 963-969
        • Basiakos S
        • Gräf M
        • Preising MN
        • Lorenz B.
        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
        • Shah AS
        • Dodd MMU
        • Gokyigit B
        • et al.
        Worldwide outcomes of nasal transposition of the split lateral rectus muscle for strabismus associated with 3rd-nerve palsy.
        Br J Ophthalmol. 2021; (bjophthalmol-2021-319667)
        • Oke I
        • Basiakos S
        • Lorenz B
        • et al.
        Nasal transposition of the split lateral rectus muscle for strabismus associated with bilateral 3rd-nerve palsy.
        Am J Ophthalmol. 2022; (S0002-9394(22)00246-X)
        • Harris PA
        • Taylor R
        • Thielke R
        • Payne J
        • Gonzalez N
        • Conde JG.
        Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support.
        J Biomed Inform. 2009; 42: 377-381
        • Hunter DG
        • Yonekawa Y
        • Shah AS
        • Dagi LR.
        Central serous chorioretinopathy following medial transposition of split lateral rectus muscle for complete oculomotor nerve palsy.
        J AAPOS. 2017; 21: 517-518
        • Sorenson R
        • Soni A.
        Central serous chorioretinopathy following medial transposition of split lateral rectus muscle for complete oculomotor nerve palsy.
        J AAPOS. 2017; 21: 161-162
        • Mehendale RA
        • Dagi LR
        • Wu C
        • Ledoux D
        • Johnston S
        • Hunter DG.
        Superior rectus transposition and medial rectus recession for Duane syndrome and sixth nerve palsy.
        Arch Ophthalmol. 2012; 130: 195-201