PURPOSE

To determine the success rate and complications associated with nasal transposition of the split lateral rectus muscle (NTSLR) for treating bilateral 3^rd-nerve palsy.

DESIGN

Retrospective, interventional case series.

METHODS

An international, multicenter registry was used for the study. The study population was all patients with bilateral 3^rd-nerve palsy treated with NTSLR. Sensorimotor evaluations were conducted before and 6 months after unilateral or bilateral NTSLR. Outcome measures were postoperative horizontal alignment ≤15 prism diopters (PD), intraoperative technical difficulties, and vision-threatening complications. The association of patient demographics and surgical technique with each outcome was analyzed using multivariable logistic regression.

RESULTS

A total of 34 patients were included, with a median age of 46 years (interquartile range [IQR] = 25-54 years) at surgery. The most common etiologies were ischemic (29%), neoplastic (15%), and congenital (12%). NTSLR performed unilaterally with alternative surgery on the opposite eye (65%) resulted in a median postoperative exotropia of 18 PD (IQR = 7-35 PD), and when performed bilaterally (35%) resulted in postoperative exotropia of 14 PD (IQR = 5-35 PD). Success was achieved in 50% of cases, intraoperative technical difficulties were reported in 18%, and vision-threatening complications occurred in 21%. Attachment of the lateral rectus muscle ≥10 mm posterior to the medial rectus insertion was associated with increased vision-threatening complications (odds ratio = 9.0; 95% CI = 1.3-99).

CONCLUSIONS

NTSLR can address the large-angle exotropia associated with bilateral 3rd-nerve palsy. Surgeons should be aware that posterior placement of the lateral rectus muscle may increase the risk of vision-threatening complications, particularly serous choroidal effusion.

中文翻译：

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双侧第三神经麻痹相关斜视的裂侧直肌鼻转位

目的

确定分离侧直肌（NTSLR）鼻转位治疗双侧^第三神经麻痹的成功率和相关并发症。

设计

回顾性、介入性病例系列。

方法

该研究使用了一个国际多中心登记处。研究人群为所有接受NTSLR 治疗的双侧^{第三神经麻痹患者。}在单侧或双侧 NTSLR 之前和之后 6 个月进行感觉运动评估。结果指标是术后水平对齐≤15棱镜屈光度（PD）、术中技术困难和威胁视力的并发症。使用多变量逻辑回归分析患者人口统计学和手术技术与每个结果的关联。

结果

共纳入 34 名患者，手术时的中位年龄为 46 岁（四分位距 [IQR] = 25-54 岁）。最常见的病因是缺血性 (29%)、肿瘤性 (15%) 和先天性 (12%)。单侧进行 NTSLR 并在对侧进行替代手术 (65%) 导致术后外斜视中位数为 18 PD (IQR = 7-35 PD)，当双侧进行时 (35%) 导致术后外斜视 14 PD (IQR = 5-35 PD）。50% 的病例取得了成功，18% 报告了术中技术困难，21% 发生了威胁视力的并发症。外直肌附着在内直肌后方≥10 mm 与威胁视力的并发症增加相关（比值比 = 9.0；95% CI = 1.3-99）。

结论

NTSLR 可以解决与双侧第三神经麻痹相关的大角度外斜视。外科医生应该意识到，外直肌后置可能会增加威胁视力的并发症的风险，尤其是浆液性脉络膜积液。