Nasal Transposition of the Split Lateral Rectus Muscle for Strabismus Associated With Bilateral 3rd-Nerve Palsy

Oke, Isdin; Shah, Ankoor S.; Lorenz, Birgit; Basiakos, Sotirios; Gökyiğit, Birsen; Dodd, Mary-Magdalene Ugo; Laurent, Erick; Hunter, David G.; Goberville, M.; Elkamshoushy, Amr; Tsai, Chong-Bin; Örge, Faruk; Velez, Federico G.; Jeddawi, Laila; Gravier, Nicholas; Li, Ningdong; Dagi, Linda R.

doi:10.1016/j.ajo.2022.06.010

Cited by 4 publications

(4 citation statements)

References 19 publications

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“…There may also be differences in the classification of partial vs. complete 3 rd -nerve palsy, as evidenced by the less than expected correlation with preoperative deviation identified in previous studies using this registry. 4,5 A prospectively designed study would limit this source of bias; however, such an approach is not readily feasible for such a rare condition. The association between partial cranial nerve palsy and aberrancy pattern may also be confounded by greater ability to appreciate alteration in lid height in cases of complete 3 rd nerve palsy.” In addition, there may be inherent selection bias in the cases of 3 rd -nerve palsy included in the registry as they have been referred to academic centres specialising in a procedure that may not be routinely performed in other regions.…”

Section: Discussionmentioning

confidence: 99%

“…The methodology for investigator recruitment and data collection has been reported previously. 4,5 Briefly, investigators were recruited through national and international paediatric ophthalmology and strabismus associations and electronic mailing lists. A Research Electronic Data Capture (REDCap) 6 registry was designed to facilitate the collection of patient demographics, aetiology and severity of the 3 rd -nerve palsy, and sensorimotor examinations.…”

Section: Methodsmentioning

confidence: 99%

“…A value of 15 PD was chosen because this magnitude of exotropia is below the threshold typically perceived by lay observers 7 and has been used as the primary outcome in previous studies using this registry. 4,5 Secondary outcomes included patient satisfaction, postoperative diplopia, and secondary strabismus surgery and ptosis surgery.…”

Section: Methodsmentioning

confidence: 99%

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Aberrant regeneration in an international registry of patients with 3rd-nerve palsy

Oke

Lorenz

Basiakos

et al. 2023

European Journal of Ophthalmology

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Background/Aims To describe the patterns of pre-operative aberrant regeneration and motility outcomes reported in an international registry of patients with 3rd-nerve palsy treated with nasal transposition of the split lateral rectus muscle (NTSLR). Methods This cross-sectional study used data from an international, multicentre registry of patients with 3rd-nerve palsy treated with NTSLR. Patients with aberrant regeneration were identified, and patterns of innervation described. Demographics and postoperative success defined as horizontal alignment ≤15 PD were compared based on the presence, and type, of aberrant regeneration using Wilcoxon rank sum and Fisher's exact tests. Results Aberrant regeneration was reported in 16% (21/129) of patients. Age at diagnosis, sex, and aetiology of palsy were not significantly associated with aberrant regeneration. Abnormal movements were triggered by adduction in 52% (11/21), infraduction in 23% (5/21), and supraduction in 23% (5/21) of cases. Presentation patterns involved rectus muscle innervation in 29% (6/21) and levator muscle innervation in 71% (15/21) of cases. Although patients with aberrant regeneration had similar probability of success in comparison to those without following NTLSR (76% vs. 69%, p = 0.5), those with abnormal innervation of a rectus muscle had a lower success rate than those with abnormal innervation of the levator palpebrae superioris muscle (17% vs. 93%; p = 0.002). Conclusion Successful treatment of a 3rd nerve palsy with NTSLR was not influenced by aberrant regeneration involving the levator muscle. Alternative surgical interventions should be considered when aberrant regeneration alters rectus muscle function given its adverse impact on motor outcomes with NTSLR.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Aberrant regeneration in an international registry of patients with 3rd-nerve palsy

Oke

Lorenz

Basiakos

et al. 2023

European Journal of Ophthalmology

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Rehabilitative surgery for oculomotor nerve palsy

2023

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QR-Code scannen & Beitrag online lesenAugenmuskeloperationen bei Okulomotoriusparese dienen zur Wiederherstellung der normalen Physiognomie und sollen die Voraussetzung für normales Binokularsehen schaffen. Hierzu sind Muskeltranspositionen geeignet [1][2][3][4]. Zur Ptosisbehandlung lassen sich eventuell bestehende Fehlinnervationen nutzen. Wir berichten über eine torsionsfreie nasal superiore Lateralistransposition mit späterer Ptosisreduktion. AnamneseDie 15-jährige Patientin mit bis dahin unauffälliger Anamnese erlitt im Alter von 8 Jahren ein Schädel-Hirn-Trauma mit links mesenzephalen und beidseits subarachnoidalen Blutungen. Das Trauma hinterließ psychovegetative, sensorischeund motorische Störungen, u. a. eine rechtsseitige Hemiparese und Okulomotoriusparese. Die Mydriasis fiel schon dem Notarzt auf. Weitere Symptome zeigten sich nach Erwachen aus dem Koma. Es erfolgten umfangreiche Rehabilitationsmaßnahmen. In dieser Zeit besserte sich die anfangs komplette Ptosis. Wegen störender Diplopie trug die Patientin eine Okklusionskontaktlinse. Sie wurde zur operativen Behandlung der Schielstellung vorgestellt.

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