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Worldwide outcomes of nasal transposition of the split lateral rectus muscle for strabismus associated with 3rd-nerve palsy
  1. Ankoor S Shah1,2,
  2. Mary-Magdalene Ugo Dodd1,2,
  3. Birsen Gokyigit3,
  4. Birgit Lorenz4,
  5. Erick Laurent5,
  6. Mohammad Ali Ayaz Sadiq6,7,
  7. Chong-Bin Tsai8,
  8. Nicolas Gravier9,
  9. Mitra Goberville10,
  10. Sotirios Basiakos11,12,
  11. David Zurakowski13,
  12. Linda R Dagi1,2
  13. for the NTSLR3NP Study Group
    1. 1Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, USA
    2. 2Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
    3. 3Pediatric Ophthalmology and Strabismus, Prof Dr N Reşat Belger Beyoglu Education and Research Eye Hospital, Istanbul, Turkey
    4. 4Ophthalmology, Justus-Liebig-University, Universitätsklinikum Gießen und Marburg GmbH, Gießen, Germany
    5. 5Centre d'Ophtalmologie du Lez, Clinique St Jean, Montpellier, France
    6. 6Institute of Ophthalmology, King Edward Medical University, Lahore, Pakistan
    7. 7Institute of Ophthalmology, Mayo Hospital Lahore, Lahore, Pakistan
    8. 8Ophthalmology, Chiayi Christian Hospital, Chia-Yi, Taiwan
    9. 9Unité de Strabologie-Polyclinique de l'Atlantique, Nantes-Saint-Herblain Cedex, France
    10. 10Centre Ophtalmologique Lauriston, Paris, France
    11. 11Ophthalmology, Justus Liebig Universitat Giessen, Giessen, Germany
    12. 12Thessaloniki, Central Macedonia, Greece
    13. 13Anesthesia, Boston Children's Hospital, Boston, Massachusetts, USA
    1. Correspondence to Dr Linda R Dagi, Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, USA; linda.dagi{at}childrens.harvard.edu

    Abstract

    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 post-procedure 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.

    • muscles
    • treatment surgery

    Data availability statement

    Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. Deidentified participant data are stored in a RedCAP registry administered by Boston Children’s Hospital and available from LRD, MD (linda.dagi@childrens.harvard.edu).

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    Data availability statement

    Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. Deidentified participant data are stored in a RedCAP registry administered by Boston Children’s Hospital and available from LRD, MD (linda.dagi@childrens.harvard.edu).

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    Footnotes

    • Twitter @MA_Sadiq

    • Presented at Association of Pediatric Ophthalmology and Strabismus Annual Meeting, March 2018 (subset of data presented). Joint meeting of the European and International Strabismological Associations, April 2021

    • Collaborators NTSLR3NP Study Group: Sumita Agarkar (India), Francois Audren (France), Ana Luiza Costa (Brazil), Linda R Dagi (USA), Mary-Magdalene Ugo Dodd (USA), Jan Tjeerd de Faber (Netherlands), Amr Elkamshoushy (Egypt), Ronit Friling (Israel), Mitra Goberville (France), Birsen Gokyigit (Turkey), Michael Gräf (Germany), Nicolas Gravier (France), Mauro Goldchmit (Brazil), Gena Heidary (USA), David Hunter (USA), Laila Jeddawi (Saudi Arabia), Madhu Karna (India), Erick Laurent (France), Birgit Lorenz (Germany), Ningdong Li (China), Iason S Mantagos (USA), Pilar Merino-Sanz (Spain), Faruk Orge (USA), Sanket R Nirgude (India), Mohammad Ali Sadiq (Pakistan), Rohit Saxena (India), Ankoor S Shah (USA), Veeral Shah (USA), Pradeep Sharma (India), James Banks Shepherd (USA), Ajay Soni (USA), Claude Speeg-Schatz (France), Alain Spielmann (France), Mitchell Strominger (USA), Jaspreet Sukhija (India), Chong-Bin Tsai (Taiwan), Federico G Velez (USA), Tamara Wygnanski-Jaffe (Israel).

    • Contributors ASS: conceptualisation, methodology, software, formal analysis, investigation, resources, data curation, writing – original draft, visualisation. M-MUD: methodology, software, formal analysis, data curation, writing – original draft. BG: investigation, writing – review and editing. BL: investigation, writing – review and editing. EL: investigation, writing – review and editing. MAAS: investigation, writing – review and editing. C-BT: investigation, writing – review and editing. NG: investigation, writing – review and editing. MG: investigation, writing – review and editing. SB: investigation, writing – review and editing. DZ: methodology, formal analysis, visualisation. LRD: guarantor, conceptualisation, methodology, software, formal analysis, investigation, data curation, writing – original draft, visualisation, supervision, funding acquisition.

    • Funding Children’s Hospital Ophthalmology Foundation Chair funds held by senior author.

    • Competing interests ASS: Medtronic (Stock interest); Rebion (Royalties); Pfizer (Stock interest). LRD: honoraria for speaking at academic centres: Texas Children’s Hospital, Canadian Ophthalmological Society, UCSF Department of Ophthalmology, Kellogg Eye Center where early data were discussed, Pfizer (Stock interest).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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