Superior Oblique Anterior Transposition with Horizontal Recti Recession-Resection for Total Third-Nerve Palsy.

Muhsin Eraslan,Mehdi Suha Ogut,Eren Cerman,Sumru Onal

doi:10.1155/2015/780139

Muhsin Eraslan, Mehdi Suha Ogut + Show 2 more

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https://doi.org/10.1155/2015/780139

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Abstract

Aims. To report the results of lateral rectus muscle recession, medial rectus muscle resection, and superior oblique muscle transposition in the restoration and maintenance of ocular alignment in primary position for patients with total third-nerve palsy. Methods. The medical records of patients who underwent surgery between March 2007 and September 2011 for total third-nerve palsy were reviewed. All patients underwent a preoperative assessment, including a detailed ophthalmologic examination. Results. A total of 6 patients (age range, 14–45 years) were included. The median preoperative horizontal deviation was 67.5 Prism Diopter (PD) (interquartile range [IQR] 57.5–70) and vertical deviation was 13.5 PD (IQR 10–20). The median postoperative horizontal residual exodeviation was 8.0 PD (IQR 1–16), and the vertical deviation was 0 PD (IQR 0–4). The median correction of hypotropia following superior oblique transposition was 13.5 ± 2.9 PD (range, 10–16). All cases were vertically aligned within 5 PD. Four of the six cases were aligned within 10 PD of the horizontal deviation. Adduction and head posture were improved in all patients. All patients gained new area of binocular single vision in the primary position after the operation. Conclusion. Lateral rectus recession, medial rectus resection, and superior oblique transposition may be used to achieve satisfactory cosmetic and functional results in total third-nerve palsy.

Highlights

Oculomotor nerve palsy, in contrast to paralysis of the fourth or sixth cranial nerves that may affect the function of only one extraocular muscle, may affect the function of four of the six extraocular muscles
We reviewed the medical records of six patients who were evaluated at our pediatric ophthalmology and strabismus clinic from March 2007 to September 2011
All the cases were aligned within 5 Prism Diopter (PD) of vertical deviation, and four of the six cases were aligned within 10 PD of horizontal deviation

Summary

Introduction

Oculomotor nerve palsy, in contrast to paralysis of the fourth or sixth cranial nerves that may affect the function of only one extraocular muscle, may affect the function of four of the six extraocular muscles. In complete third-nerve palsy the eye is fixed in a position of abduction, depression, and intorsion, because of the two remaining functional muscles, the lateral rectus and the superior oblique. In partial third-nerve palsy any or all of these functions may be incompletely effected. The surgical correction of oculomotor nerve palsy remains a challenge for ophthalmologists. The main goal of surgery in total third-nerve palsy is to align the paralyzed eye in a primary position, regardless of which surgical procedure is employed. Various surgical techniques have been described to achieve this goal [1]

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Conclusion