Splitting of the lateral rectus muscle with medial transposition to treat oculomotor palsy: a retrospective analysis of 29 consecutive cases
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The lateralis splitting technique has been an interesting option for treating large-angle exotropia due to complete 3rd nerve paralysis since its inception in the early 1990s. The purpose of this study is to report on our experience regarding the effectiveness and complications of this method.
Retrospective analysis of a consecutive series of 29 patients operated by one single experienced surgeon and examined according to a specific operative and perioperative protocol. Patients were examined preoperatively, on the 2nd day and 3rd month after surgery. Outcome measures include strabismus angle, horizontal motility, head turn, binocular function, and incidence and resolution of postoperative serous retinal detachment as seen with infrared imaging and spectral domain optical coherence tomography (SD-OCT).
Surgery brought about a large and stable reduction of strabismus angle and head turn. It reduced horizontal motility, but moved the range of monocular excursion much closer to center. Eighty percent of patients with constant diplopia acquired some fields of single binocular vision. A significant number of cases (33.3%) developed transitory serous retinal detachment with varying onset and extent.
This is by far the largest published study regarding the outcome of lateralis splitting in NIII palsy. The procedure is difficult, yet a very useful option. Serous detachment is a serious complication, but usually transitory. Its cause and mechanisms are not fully understood and warrant further investigation.
KeywordsLateral rectus splitting Lateral rectus nasal transposition Third nerve palsy Paralytic strabismus
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures involving human participants were in accordance with the ethical standards of the institutional research committee (case number AZ 02/18) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 1.Helveston EM (1972) Muscle transposition procedures. Surv Ophthalmol 16:92–97Google Scholar
- 5.Ameri A, Jafari AK, Anvari F, Rezvan J, Fard MA (2010) Simplified use of suture fixation associated with lateral rectus myectomy in management of complete third nerve palsy. J Pediatr Ophthalmol Strabismus 23:47Google Scholar
- 8.Scott AB, Miller JM, Collins CC (1992) Eye muscle prosthesis. J Pediatr Ophthalmol Strabismus 29:216–218Google Scholar
- 9.Bicas HE (1991) A surgically implanted elastic band to restore paralyzed ocular rotations. J Pediatr Ophthalmol Strabismus 28(1):10–13Google Scholar
- 12.Salazar-Leon JA, Ramırez-Ortız MA, Salas-Vargas M (1998) The surgical correction of paralytic strabismus using fascia lata. J Pediatr Ophthalmol Strabismus 35:27–32Google Scholar
- 13.Villaseñor Solares J, Riemann BI, Romanelli Zuazo AC, Riemann CD (2000) Ocular fixation to nasal periosteum with a superior oblique tendon in patients with third nerve palsy. J Pediatr Ophthalmol Strabismus 37(5):260–265Google Scholar
- 16.Wiener M (1928) Correction of defect due to third nerve paralysis. Arch Ophthalmol 57:597Google Scholar
- 20.Kaufmann H (1991) “Lateralis splitting” in total oculomotor paralysis with trochlear nerve paralysis. Fortschr Ophthalmol 88(3):314–316Google Scholar
- 21.Kaufmann H (2011) Operative Versorgung der Okulomotoriusparese. ZPA 32:329–334Google Scholar
- 22.Kaufmann H (2012) Strabismus, 4th edn. Georg Thieme Verlag KG, Stuttgart, p 609Google Scholar
- 33.Aygit ED, İnal A, Ocak OB, Celik S, Fazıl K, Yildiz BK, Taskapili M, Gokyigit B (2017) Simplified approach of Gokyigit’s technique for complete cranial nerve third palsy. Int Ophthalmol 23Google Scholar