TY - JOUR
T1 - Worldwide outcomes of nasal transposition of the split lateral rectus muscle for strabismus associated with 3rd-nerve palsy
AU - the NTSLR3NP Study Group
AU - Shah, Ankoor S.
AU - Dodd, Mary Magdalene Ugo
AU - Gokyigit, Birsen
AU - Lorenz, Birgit
AU - Laurent, Erick
AU - Sadiq, Mohammad Ali Ayaz
AU - Tsai, Chong Bin
AU - Gravier, Nicolas
AU - Goberville, Mitra
AU - Basiakos, Sotirios
AU - Zurakowski, David
AU - Dagi, Linda R.
AU - Audren, Francois
AU - Costa, Ana Luiza
AU - de Faber, Jan Tjeerd
AU - Elkamshoushy, Amr
AU - Friling, Ronit
AU - Gräf, Michael
AU - Goldchmit, Mauro
AU - Heidary, Gena
AU - Hunter, David
AU - Jeddawi, Laila
AU - Karna, Madhu
AU - Li, Ningdong
AU - Mantagos, Iason S.
AU - Merino-Sanz, Pilar
AU - Orge, Faruk
AU - Nirgude, Sanket R.
AU - Saxena, Rohit
AU - Shah, Veeral
AU - Sharma, Pradeep
AU - Shepherd, James Banks
AU - Soni, Ajay
AU - Speeg-Schatz, Claude
AU - Spielmann, Alain
AU - Strominger, Mitchell
AU - Sukhija, Jaspreet
AU - Velez, Federico G.
AU - Wygnanski-Jaffe, Tamara
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2023.
PY - 2023/5
Y1 - 2023/5
N2 - Background/aims To determine success rate and complications associated with nasal transposition of the split lateral rectus muscle (NTSLR) for treating strabismus from 3rd-nerve palsy. Methods An international, multicentre, registry of patients with unilateral 3rd-nerve palsy treated with NTSLR was created. Patients with concurrent surgery on the contralateral eye were excluded. Primary outcome was horizontal alignment within 15 prism dioptres (PD) of orthotropia. Incidence of technical difficulties and vision-threatening complications by 6 months postprocedure were reported. Results Ninety-eight patients met inclusion criteria. Median age was 33.5 years (IQR 10.75–46). Aetiologies included congenital (31%), neoplastic (16%) and traumatic (15%). Twenty-five per cent of patients had prior ipsilateral strabismus surgery. Median exotropia decreased from 70PD preoperatively (IQR 50–90) to 1PD postoperatively (IQR 0–15.5), with a success rate of 69%. Performing concurrent superior oblique muscle tenotomy (SOT) was independently associated with success (p=0.001). Technical challenges occurred in 30% of cases, independently associated with a history of ipsilateral strabismus surgery (p=0.01). Eleven per cent of patients had vision-threatening complications, independently associated with more posterior placement of the split lateral rectus (LR) muscle (p<0.001), and most commonly transient serous choroidal effusion. Surgical placement of the split LR muscle within 4.25 mm of the medial rectus (MR) muscle insertion reduced this risk. Conclusion NTSLR significantly improved primary position alignment altered by 3rd-nerve palsy. Concurrent SOT and placement of the split LR muscle ≤4.25 mm posterior to the MR muscle insertion optimised outcomes. NTSLR proved technically challenging when prior ipsilateral strabismus surgery had been performed.
AB - Background/aims To determine success rate and complications associated with nasal transposition of the split lateral rectus muscle (NTSLR) for treating strabismus from 3rd-nerve palsy. Methods An international, multicentre, registry of patients with unilateral 3rd-nerve palsy treated with NTSLR was created. Patients with concurrent surgery on the contralateral eye were excluded. Primary outcome was horizontal alignment within 15 prism dioptres (PD) of orthotropia. Incidence of technical difficulties and vision-threatening complications by 6 months postprocedure were reported. Results Ninety-eight patients met inclusion criteria. Median age was 33.5 years (IQR 10.75–46). Aetiologies included congenital (31%), neoplastic (16%) and traumatic (15%). Twenty-five per cent of patients had prior ipsilateral strabismus surgery. Median exotropia decreased from 70PD preoperatively (IQR 50–90) to 1PD postoperatively (IQR 0–15.5), with a success rate of 69%. Performing concurrent superior oblique muscle tenotomy (SOT) was independently associated with success (p=0.001). Technical challenges occurred in 30% of cases, independently associated with a history of ipsilateral strabismus surgery (p=0.01). Eleven per cent of patients had vision-threatening complications, independently associated with more posterior placement of the split lateral rectus (LR) muscle (p<0.001), and most commonly transient serous choroidal effusion. Surgical placement of the split LR muscle within 4.25 mm of the medial rectus (MR) muscle insertion reduced this risk. Conclusion NTSLR significantly improved primary position alignment altered by 3rd-nerve palsy. Concurrent SOT and placement of the split LR muscle ≤4.25 mm posterior to the MR muscle insertion optimised outcomes. NTSLR proved technically challenging when prior ipsilateral strabismus surgery had been performed.
UR - http://www.scopus.com/inward/record.url?scp=85153410173&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85153410173&partnerID=8YFLogxK
U2 - 10.1136/bjophthalmol-2021-319667
DO - 10.1136/bjophthalmol-2021-319667
M3 - Article
C2 - 34880051
AN - SCOPUS:85153410173
SN - 0007-1161
VL - 107
SP - 725
EP - 731
JO - British Journal of Ophthalmology
JF - British Journal of Ophthalmology
IS - 5
ER -