Cover Image

Combined Lateral Rectus Myectomy and Maximal Medial Rectus Resection in Complete Third Cranial Nerve Palsy

Hajar Farvardin, Majid Farvardin, Samaneh Koohestani

Abstract


This study was performed to describe lateral rectus myectomy and maximal medial rectus resection for correction of eye deviation in complete third cranial nerve palsy. A retrospective review of thirteen patients (fourteen eyes) with complete third cranial nerve palsy, who underwent lateral rectus myectomy and maximal medial rectus resection, was performed. These procedures were combined with superior oblique tendon transposition in nine patients with a large angle of exotropia (more than 60 prism diopters [∆]), or significant hypotropia (more than 5 ∆). Preoperative deviations were exotropia of 50 to 120 ∆ in thirteen cases and hypotropia of 5 to 25 ∆ in eight cases. Six months after the surgery, eleven patients were within 10 ∆ of orthotropia in primary position. Revision surgery was performed for two patients, eight and 18 months after the first operation. Eventually, five patients (38%) achieved orthotropia in the primary position, and seven patients (54%) had < 11 ∆ exotropia and < 6 ∆ vertical deviation. In conclusion, this procedure can be considered as an acceptable approach for treatment of strabismus in complete third cranial nerve palsy. This procedure is simple and can be easily performed even in very young children.

 


References


Mazow M. Third cranial nerve palsy: diagnosis and management strategies. In: Rosenbaum A, Santiago A, editors. Clinical Strabismus Management, Principles and Surgical Techniques. 1st ed. Philadelphia: WB Saunders Company; 1999. p. 251-8.

Kose S, Uretmen O, Pamukcu K. An approach to the surgical management of total oculomotor nerve palsy. Strabismus. 2001;9(1):1-8. pmid: 11262694

Khaier A, Dawson E, Lee J. Traction sutures in the management of long-standing third nerve palsy. Strabismus. 2008;16(2):77-83. doi: 10.1080/0927397 0802077474 pmid: 18484509

Gokyigit B, Akar S, Satana B, Demirok A, Yilmaz OF. Medial transposition of a split lateral rectus muscle for complete oculomotor nerve palsy. J AAPOS. 2013;17(4):402-10. doi: 10.1016/j.jaapos.2013.05.007 pmid: 23993720

WMA. World Medical Association Declaration of Helsinki-Ethical Principles for Medical Research Involving Human Subjects Fortaleza, Brazil: WMA; 2018 [cited 2013 October ]. Available from: http://www.wma.net/en/30publications/10policies/b317c.pdf.

Rosenbaum A, Santiago A. Test of muscle function. In: Rosenbaum A, editor. Clinical Strabismus Management: Principles and Surgical Techniques. 1st ed. Philadelphia: WB Saunders Company; 1999. p. 37-51.

Metz HS. Quantitative evaluation of the strabismus patient. Int Ophthalmol Clin. 1985;25(4):13-36. pmid: 4077417

Sato M, Maeda M, Ohmura T, Miyazaki Y. Myectomy of lateral rectus muscle for third nerve palsy. Jpn J Ophthalmol. 2000;44(5):555-8. doi: 10.1016/s0021-5155(00)00212-4 pmid: 11033136

Young TL, Conahan BM, Summers CG, Egbert JE. Anterior transposition of the superior oblique tendon in the treatment of oculomotor nerve palsy and its influence on postoperative hypertropia. J Pediatr Ophthalmol Strabismus. 2000;37(3):149-55. pmid: 10845415

Velez FG, Thacker N, Britt MT, Alcorn D, Foster RS, Rosenbaum AL. Rectus muscle orbital wall fixation: a reversible profound weakening procedure. J AAPOS. 2004;8(5):473-80. doi: 10.1016/S1091853104001314 pmid: 15492742

von Noorden G, Campos E. Paralytic Strabismus. Binocular Vision and Ocular Motility. 6th ed. St Louis: Mosby; 2002.

Sharma P, Gogoi M, Kedar S, Bhola R. Periosteal fixation in third-nerve palsy. J AAPOS. 2006;10(4):324-7. doi: 10.1016/j.jaapos.2006.02.005 pmid: 16935231

Srivastava KK, Sundaresh K, Vijayalakshmi P. A new surgical technique for ocular fixation in congenital third nerve palsy. J AAPOS. 2004;8(4):371-7. doi: 10.1016/S1091853104000400 pmid: 15314600

Gottlob I, Reinecke RD, Catalano RA. Surgical Management of Oculomotor Nerve Palsy: Reply. Am J Ophthalmol. 1991;111(5):658-9. doi: 10.1016/s0002-9394(14)73727-4

Yonghong J, Kanxing Z, Wei L, Xiao W, Jinghui W, Fanghua Z. Surgical management of large-angle incomitant strabismus in patients with oculomotor nerve palsy. J AAPOS. 2008;12(1):49-53. doi: 10.1016/j.jaapos.2007.07.008 pmid: 18029212

Saunders RA, Rogers GL. Superior oblique transposition for third nerve palsy. Ophthalmology. 1982;89(4):310-6. doi: 10.1016/s0161-6420(82)3478 6-7 pmid: 7099551

Maruo T, Iwashige H, Kubota N, Sakaue T, Ishida T, Honda M, et al. Results of surgery for paralytic exotropia due to oculomotor palsy. Ophthalmologica. 1996;210(3):163-7. doi: 10.1159/000310699 pmid: 8738461

Salazar-Leon JA, Ramirez-Ortiz MA, Salas-Vargas M. The surgical correction of paralytic strabismus using fascia lata. J Pediatr Ophthalmol Strabismus. 1998;35(1):27-32. pmid: 9503312

Villasenor Solares J, Riemann BI, Romanelli Zuazo AC, Riemann CD. Ocular fixation to nasal periosteum with a superior oblique tendon in patients with third nerve palsy. J Pediatr Ophthalmol Strabismus. 2000;37(5):260-5. pmid: 11020106

Ameri A, Jafari AK, Anvari F, Rezvan J, Fard MA. Simplified use of suture fixation associated with lateral rectus myectomy in management of complete third nerve palsy. J Pediatr Ophthalmol Strabismus. 2010;47 Online:e1-3. doi: 10.3928/01913913-20100818-07 pmid: 21158373


Full Text: Full Text PDF

Creative Commons License
This work is licensed under a Creative Commons Attribution 3.0 License.