Surgical management of overcorrection after nasal transposition of the split lateral rectus muscle

To describe the outcome of surgical management of overcorrection after nasal transposition of split lateral rectus (NTSLR) for oculomotor nerve palsy.

The medical records of patients who underwent surgical revision for overcorrection after NTSLR from January 2014 to January 2024 were reviewed retrospectively. Details of the surgical overcorrection were analyzed. Ductions, versions, and angles of strabismus were evaluated before and after surgical revision.

Nine patients were identified. Median patient age was 37 years (IQR, 28-49; range, 8-60). Median preoperative angle of esotropia was 30^Δ (IQR, 20^Δ-30^Δ; range, 15^Δ- 40^Δ). Median time between the first surgery and reoperation was 14 days (IQR, 7-40; range, 5-102). During revision, both halves of the lateral rectus were recessed 6 mm. The average follow-up after second surgery was 7.5 months. Median angle of esotropia decreased to 10^Δ (IQR, 5^Δ-30^Δ; 15^Δ exotropia to 30^Δ esotropia) at last follow-up. Five patients (55%) were aligned within 15^Δ of orthotropia; all of these patients had surgical revision performed within the first 2 postoperative weeks. In 4 patients, the angle of deviation was unchanged or changed by only 5^Δ after surgical revision, and all of these surgical revisions were performed at least 1 month after the initial surgery. There was a statistically significant negative correlation between the amount of correction achieved and the time between the first surgery and revision (r_s = -0.87, P = 0.0022).

In our small study cohort, revision surgery following overcorrection after NTSLR by recessing the transposed lateral rectus muscle along the border of the medial rectus muscle was successful only when performed within the first 2 weeks of initial surgery.