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A new surgical technique for ocular fixation in congenital third nerve palsy
Kuldeep Kumar Srivastava1, Kannan Sundaresh, Perumalsamy Vijayalakshmi
1Aravind Eye Hospital, Tamil Nadu, India.
Purpose:
To present a new technique of ocular fixation to restore and maintain the ocular alignment in primary position for patients with total third nerve paralysis.
Method:
We fixated the globe (medial rectus muscle insertion) to the medial palpebral ligament insertion at the anterior lacrimal crest by using nonabsorbable 5-0 polyester sutures in a prospective study of 5 patients (5 eyes) with congenital total third nerve paralysis. A large recession of the lateral rectus muscle (12 to 16 mm) was also performed in four patients.
Results:
Four patients achieved satisfactory ocular alignment and one patient had residual exotropia. After an initial exotropic shift, no significant change in ocular alignment was observed during the follow-up period of 6 to 9 months. Mild fullness and congestion over the medial rectus muscle area was observed in the immediate postoperative period in all the patients, which resolved in about two months time.
Conclusion:
This technique of ocular fixation is easy, safe, and effective for the management of exotropia secondary to total third nerve paralysis.
