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Splitting of the lateral rectus muscle with medial transposition to treat oculomotor palsy: a retrospective analysis of 29 consecutive cases.

Abstract

PURPOSE

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.

METHODS

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).

RESULTS

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.

CONCLUSION

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.

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  • Authors+Show Affiliations

    ,

    Department of Ophthalmology, Justus Liebig University Giessen, Universitaetsklinikum Giessen and Marburg GmbH, Giessen Campus, Friedrichstrasse 18, 35385, Giessen, Germany.

    ,

    Department of Ophthalmology, Justus Liebig University Giessen, Universitaetsklinikum Giessen and Marburg GmbH, Giessen Campus, Friedrichstrasse 18, 35385, Giessen, Germany.

    ,

    Department of Ophthalmology, Justus Liebig University Giessen, Universitaetsklinikum Giessen and Marburg GmbH, Giessen Campus, Friedrichstrasse 18, 35385, Giessen, Germany.

    Department of Ophthalmology, Justus Liebig University Giessen, Universitaetsklinikum Giessen and Marburg GmbH, Giessen Campus, Friedrichstrasse 18, 35385, Giessen, Germany. birgit.lorenz@augen.med.uni-giessen.de.

    Source

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    31172264

    Citation

    Basiakos, Sotirios, et al. "Splitting of the Lateral Rectus Muscle With Medial Transposition to Treat Oculomotor Palsy: a Retrospective Analysis of 29 Consecutive Cases." Graefe's Archive for Clinical and Experimental Ophthalmology = Albrecht Von Graefes Archiv Fur Klinische Und Experimentelle Ophthalmologie, 2019.
    Basiakos S, Gräf M, Preising MN, et al. Splitting of the lateral rectus muscle with medial transposition to treat oculomotor palsy: a retrospective analysis of 29 consecutive cases. Graefes Arch Clin Exp Ophthalmol. 2019.
    Basiakos, S., Gräf, M., Preising, M. N., & Lorenz, B. (2019). Splitting of the lateral rectus muscle with medial transposition to treat oculomotor palsy: a retrospective analysis of 29 consecutive cases. Graefe's Archive for Clinical and Experimental Ophthalmology = Albrecht Von Graefes Archiv Fur Klinische Und Experimentelle Ophthalmologie, doi:10.1007/s00417-019-04370-7.
    Basiakos S, et al. Splitting of the Lateral Rectus Muscle With Medial Transposition to Treat Oculomotor Palsy: a Retrospective Analysis of 29 Consecutive Cases. Graefes Arch Clin Exp Ophthalmol. 2019 Jun 6; PubMed PMID: 31172264.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Splitting of the lateral rectus muscle with medial transposition to treat oculomotor palsy: a retrospective analysis of 29 consecutive cases. AU - Basiakos,Sotirios, AU - Gräf,Michael, AU - Preising,Markus N, AU - Lorenz,Birgit, Y1 - 2019/06/06/ PY - 2018/12/18/received PY - 2019/05/20/accepted PY - 2019/03/12/revised PY - 2019/6/8/entrez PY - 2019/6/7/pubmed PY - 2019/6/7/medline KW - Lateral rectus nasal transposition KW - Lateral rectus splitting KW - Paralytic strabismus KW - Third nerve palsy JF - Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie JO - Graefes Arch. Clin. Exp. Ophthalmol. N2 - PURPOSE: 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. METHODS: 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). RESULTS: 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. CONCLUSION: 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. SN - 1435-702X UR - https://www.unboundmedicine.com/medline/citation/31172264/Splitting_of_the_lateral_rectus_muscle_with_medial_transposition_to_treat_oculomotor_palsy:_a_retrospective_analysis_of_29_consecutive_cases L2 - https://dx.doi.org/10.1007/s00417-019-04370-7 DB - PRIME DP - Unbound Medicine ER -