Title : Long-term outcomes of combined lateral rectus fixation and medial rectus resection in third nerve palsy
Abstract:
Background: Strabismus caused by total third cranial nerve palsy, resulting in severe exotropia and hypotropia. This study assesses the long-term result of lateral rectus (LR) periosteal fixation combined with super-maximal medial rectus (MR) resection in total third nerve palsy.
Materials and Methods: This case series study with long-term follow-up, involved 11 Patients with total third nerve palsy who underwent LR periosteal fixation combined with super-maximal MR resection. Demographics such as age, sex, pre- and post-operative deviation, adduction and abduction limitation, dose of MR resection, exotropia drift and follow up period were collected and analyzed. Patients with prior ocular muscle surgery or Botox injections were excluded. Surgical success was defined as a residual deviation of ≤10 prism diopters (PD) of orthotropia in the primary gaze. Follow-up evaluations occurred at 1.5-, 6-, and 12-months post-surgery, with final outcomes analyzed statistically using Wilcoxon signed-rank tests and Hedge's g to evaluate the effect size.
Results: The mean age of the 11 patients was 20 years, with 63.6% being female. Preoperative deviations ranged from 60 to 90 PD. Postoperatively, 45.4% of patients achieved successful outcomes after the first surgery. Following a second surgery, all patients achieved successful alignment. Statistically significant improvements were observed across all follow-up time points, with a large effect size (Hedge's g = -4.1 at final follow-up) and a mean reduction in deviation of 68 PD.
Conclusion: The combination of LR disinsertion and super-maximum MR resection provides effective, long-term alignment in patients with total third nerve palsy. The misalignment caused by paralysis is effectively corrected through surgery, but further advancements are needed to reduce complications and prevent recurrence.
