Session: Poster session B

Long term results of lateral rectus disinsertion and reattachment to the orbital wall in complete third nerve paralysis

INTRODUCTION complete third nerve paralysis is a complex surgical challenge mainly due to the unbalanced force of the lateral rectus which inevitably causes drift towards exotropia over the long run. Detaching the muscle from the globe and re-attaching it to the orbital wall aims to solve this problem

METHODS Five patients with complete third nerve palsy were operated during the years 2003 – 2018. All patients underwent lateral rectus disinsertion and re-attachment to the orbital wall, together with superior oblique tenectomy. Medial rectus resection with/without superior rectus resection was done in order to achieve orthophoria on the operating table.      

RESULTS All patients achieved near orthophoria alignment that was cosmetically acceptable. In four patients some residual abduction and adduction movements were noted. These surgical results were stable during a follow-up period of 7-20 years.

DISCUSSION Lateral rectus disinsertion and reattachment to the orbital wall, together with superior oblique tenectomy abolish any abducting or depressing force on the globe. If ortho alignment is achieved on the operating table, it usually remains stable thereafter. Some abducting and adducting force is still generated by the lateral rectus extra-muscular attachments and by the weak medial rectus that has no counterbalance force.

 

CONCLUSION – Lateral rectus detachment and re-attachment to the orbital wall is an excellent surgical choice in patients with complete third nerve palsy. The surgical results are remarkably stable over a long follow-up period.