Abstract
Purpose :
Split-tendon medial transposition of lateral rectus (STMTLR) for complete oculomotor palsy can correct large angles of exotropia in adults, but outcomes are variable and complications are frequent. Although outcomes in pediatric cases have been reported, further insight is needed to assess the child’s ability to gain sensory function and/or demonstrate neuroplasticity post-surgically. The purpose of our study is to report the outcomes of this technique in pediatric cases of complete oculomotor palsy.
Methods :
A retrospective review of outcomes was conducted on 5 consecutive patients with complete oculomotor palsy treated with STMTLR by a single surgeon between 2012-2019 at a tertiary pediatric referral center. All patients underwent unilateral surgery utilizing the same technique. Primary outcome was postoperative horizontal alignment, and secondary outcome was demonstration of gain-of-function activity in the field of action of the paretic medial rectus muscle.
Results :
Patients averaged 5.3 years old (range 10m-16y). Two were female. Etiologies were heterogeneous, with two subjects possessing bilateral disease secondary to miliary tuberculosis with CNS involvement, two with congenital unilateral palsy, and one iatrogenic case resulting from a pineal gland tumor extraction. All presented with oculomotor palsy with a mean preoperative exotropia of 75 ± 33.96 prism diopters (PD, range 35 to >120). Mean surgical decrease in exotropia was 49 ± 15.47 PD (range 37.5 to 75). Both patients with congenital oculomotor palsy regained convergence.
Conclusions :
STMTLR was a safe and effective approach for the surgical correction of pediatric oculomotor palsy in our case series. If performed early, pediatric patients may additionally benefit in potential gain-of-function activity in the transposed lateral rectus muscle owing to the adaptive neuroplasticity of childhood.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.