Medial transposition of a split lateral rectus muscle for complete oculomotor nerve palsy

To evaluate the effect on ocular alignment of Y splitting the lateral rectus muscle and then reattaching the 2 ends near the medial rectus muscle insertion in patients with complete oculomotor nerve palsy.

All eyes with oculomotor nerve palsy treated between May 2008 and February 2010 with Y splitting and transposition of the lateral rectus muscle to the medial rectus muscle were prospectively studied. In this procedure, the lateral rectus muscle was split: the upper half was transposed to the superior border and the lower half to the inferior border of the medial rectus insertion. For the muscles that had lost the ability to stretch and strain due to fibrosis, a hang-back technique was used. In some patients, the medial rectus muscle of the same eye was subsequently strengthened or the lateral rectus muscle of the fellow eye was recessed. Final deviation from 0(Δ) to 10(Δ) was considered a successful result.

A total of 10 patients were included. Patients had a preoperative horizontal deviation >45(Δ) (range, 45(Δ)-90(Δ)). Of the 10 patients, 5 attained stable results following surgery, and 5 with postoperative undercorrection between 20(Δ) and 30(Δ) required further surgeries. Postoperatively, 2 patients improved their sensorial status in a very limited range of gaze and 2 patients had symptomatic diplopia.

Acceptable aesthetic results can be achieved in the treatment of complete oculomotor nerve palsy with the transposition of the split lateral rectus muscle to the medial rectus muscle area.