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Lateral rectus muscle disinsertion and reattachment to the lateral orbital wall
  1. Y Morad1,
  2. L Kowal2,
  3. A B Scott3
  1. 1Pediatric Ophthalmology Service, Assaf Harofeh Medical Center, Tel-Aviv University, Zrifin, Israel
  2. 2Centre for Eye Research Australia and Ocular Motility Clinic, Royal Victorian Eye and Ear Infirmary, Melbourne, Australia
  3. 3Smith-Kettlewell Eye Research Institute, San Francisco, CA, USA
  1. Correspondence to: Alan B Scott MD, Smith-Kettlewell Eye Research Institute 2318 Fillmore Street, SF, CA 94115, USA; absski.org

Abstract

Background/aims: Surgical correction of ocular alignment in patients with third cranial nerve paralysis is challenging, as the unopposed lateral rectus muscle often pulls the eye back to exotropia following surgery. The authors present a simple surgical approach to overcome this difficulty. This approach is also applicable to removal of unwanted overactivity of the lateral rectus in Duane syndrome.

Methods: A review was made of the records of four patients with third cranial nerve paralysis and one with Duane syndrome with exotropia in which the lateral rectus muscle was removed from its scleral insertion and reattached to the orbital wall. Additional surgery to bring the eye to the midline included medial rectus resection, medial transposition of the vertical recti, and passive suturing of the eye to the medial orbit wall.

Results: All patients achieved satisfactory ocular alignment following surgery. Ocular ductions were limited. These results were stable for 1.5–4 years of follow up. No major complications occurred.

Conclusion: Lateral rectus muscle disinsertion and reattachment to the orbital wall to absorb its force and thus remove abduction torque was a simple and safe surgical procedure for restoring ocular alignment in four patients with third cranial nerve paralysis and in one patient with Duane syndrome with severe exotropia.

  • IR, inferior rectus
  • MRI, magnetic resonance imaging
  • SR, superior rectus
  • lateral rectus muscle disinsertion
  • orbital wall
  • Duane syndrome
  • IR, inferior rectus
  • MRI, magnetic resonance imaging
  • SR, superior rectus
  • lateral rectus muscle disinsertion
  • orbital wall
  • Duane syndrome
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Footnotes

  • Supported in part by National Institutes of Health, National Eye Institute, under award number R01 EY12216, and by Pacific Vision Foundation.

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