Adjustable nasal transposition of split lateral rectus muscle for third nerve palsy

Area of Science:

• Ophthalmology
• Strabismus Surgery
• Neuro-ophthalmology

Background:

• Third nerve palsy frequently results in disfiguring, incomitant strabismus.
• Existing correction options for this condition are limited.
• A novel surgical approach is needed to address these challenges.

Purpose of the Study:

• To evaluate the efficacy of adjustable nasal transposition of the split lateral rectus (LR) muscle.
• To assess oculomotor outcomes, anatomical changes, and complications.
• To determine the utility of this technique in managing third nerve palsy.

Main Methods:

• Retrospective review of 6 patients with third nerve palsy undergoing adjustable nasal transposition of the split LR muscle.
• Follow-up ranged from 5 to 25 months.
• Outcomes assessed included horizontal/vertical alignment, adjustable positioning utility, anatomical changes via MRI, and complications.

Main Results:

• Four of 6 patients had successful procedures, with 3 achieving orthotropia.
• Median horizontal deviation improved from 68 prism diopters exotropia to 0 (P = .04).
• Intraoperative adjustments were utilized in all successful cases; MRI confirmed globe tethering without optic nerve contact. One patient experienced transient complications.

Conclusions:

• Adjustable nasal transposition of the split LR muscle can yield excellent oculomotor alignment in select third nerve palsy cases.
• The adjustable feature allows for precise alignment optimization.
• Careful case selection is vital, as prior surgeries or muscle contracture can impede success and increase complication risks.