Surgery for third nerve palsy (2019)
Reviewed by Fiona Rowe

The authors present a new technique for split muscle medial transposition surgery of the lateral rectus plus union with the distal split stump of the medial rectus. This increases the length of the contracted lateral rectus through the addition of the medial rectus stump. Added transposition of the lateral rectus to the optimal filarum produces effective adduction. The study included 10 eyes of 10 patients (seven male, three female) with mean age of 32.4 years (±18.4) with complete third nerve palsy. The right eye was involved in five eyes and the left in five eyes. Mean time from onset to surgery was 6.5±8.7 years with mean follow-up of 13.2±7.9 months. Mean preoperative exotropia was 84±14.9PD reducing to 6.5±8.2PD at final follow-up. Mean vertical deviation was 16.5±10PD preoperatively reducing to 2.5±3.5PD at follow-up. The overall success rate was 70% for the horizontal deviation and 90% for the vertical deviation. Limited adduction was improved in all cases with mean improvement of +2.9±1.3 grading. Mean abduction reduction was -1.8±0.8 grading. Elevation and depression also improved. The authors conclude this procedure is effective and long-lasting to overcome large angle exotropia and can be used as a first or reoperation procedure.

Lateral rectus-medial rectus union: a new surgical technique for treatment of complete third nerve palsy.
Bagheri A, Feizi M, Sahebghalam R, Yazdani S.
JOURNAL OF PEDIATRIC OPHTHALMOLOGY AND STRABISMUS
2019;56:10-8.