Surgical management of IIIcnp
Reviewed by Jonathan Chan

This was a retrospective review of a cohort of patients with complete third nerve palsy (IIIcnp) managed by a surgical technique of full tendon transposition (FTT) of the lateral rectus (LR) to the medial rectus (MR) augmented with posterior fixation sutures in four patients over one year period. Forced duction test (FDT) was performed in all patients and if the LR was tight on adduction, another technique was performed. For two patients with exotropia (XT) and hypertropia (HT), the LR was disinserted and passed under the inferior oblique (IO) and reattached below the insertion of MR. Augmentation sutures with 5-0 Ethibond were used 8mm behind the new insertion and a scleral bite (including 1/3 of muscle fibres in each bite) was applied. For two patients with XT and hypotropia (HoT), the LR was passed under the superior rectus (SR), superior oblique (SO) after posterior tenectomy of the muscle and reattached at the upper border of the (MR) along with augmentation sutures. The authors recommended that this technique is suitable for patients with associated large vertical deviations (>20 prism dioptres) and negative FDT.

Full tendon medial transposition of lateral rectus (LR) with augmentation sutures in cases of complete third nerve palsy.
Saxena R, Sharma M, Singh D, Sharma P.
BRITISH JOURNAL OF OPHTHALMOLOGY
2018;102:715-7.