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1. 3-year results of the German nationwide survey on eye injuries caused by fireworks

Author

Gabel-Pfisterer, A., Boehringer, D., Agostini, H., Fuest, M., Walter, P., Botros, Y., Mueller, A., Al-Ashi, N., Lenglinger, M., Mueller, B., Schoenfeld, S., Seibel, I., Joussen, A., Breuss, H., Kuchenbecker, J., Foerster, M. H., Berthold, A., Wirbelauer, C., Hofmayer, H., Wachtlin, J., Palka, K., Niemeyer, M., Walla, T., Pham, D., Aisenbrey, S., Tatsiou, A., Walch, A., Burk, R., Schultz, T., Tsiampalis, N., Rehmann, J., Sliwowska, U., Schojai, M., Schulze, K., Kamguia, N., Wirtz, C., Dick, B., Voelker, D., Wintergerst, M., Pfau, M., Melzer, C., Hoegen, D., Bosch, F., Andresen, J. C., Krohne, T., Holz, F., Kathke, M., Sturm, A., Noske, W., Huebner, T., Brandner, S., Feldmann, M., Morsek, J., Rainer, O., Bartsch, H., Ewald, K., Chankiewitz, E., Siegmund, T., Bohlen, A., Mohr, A., Hecker, J., Strassburger, P., Furashova, O., Engelmann, K., Krieb, A., Emmerich, K., Grajewski, L., Krause, L., Jabur, A., Ruediger, K., Lehmann, F., Sachs, H., Matthee, E., Steindorf, F., Schnitzler, C., Neumann, I., Korbmacher, J., Geerling, G., Doulgkeridis, J., Erhard, J., Dahms-Dowidat, K., Kotiasvili, T., Jagow, B. V., Lieder, A., Blum, M., Westerkemper, H., Boehm, M., Bornfeld, N., Bechrakis, N., Schultheiss, M., Scheider, A., Mueller, M., Kohnen, T., Eckert, T., Eckardt, C., Wisniewska, M., Just, A., Jehle, V., Reinhard, T., Seewald, J., Mais, C., Basiakos, S., Osman, B., Xanthopoulou, E., Friedburg, B., Graef, M., Lorenz, B., Just, U., Naxer, S., Oterendorp, C., Bemme, S., Callizo, J., Feltgen, N., Hoerauf, H., Menges, A., Tost, F., Stahl, A., Huth, A., Viestenz, A., Bertram, P., Skevas, C., Kromer, R., Casagrande, M., Grohmann, C., Mehlan, J., Schindler, P., Spitzer, M., Schargus, M., Eddy, M., Schumacher, S., Keserue, M., Scheler, A., Stemplewitz, B., Schaudig, U., Abou Moulig, W., Framme, C., Rosenthal, A., Hesse, L., Kunz, L., Spira, C., Suffo, S., Seitz, B., Wietstock, G., Augsten, R., Meller, D., Mayer, M., Vanselow, K., Lieb, W., Beutner, A., Effert, R., Ehlken, C., Roider, J., Hueber, A., Cursiefen, K., Schrage, N., Kroeger, M., Viehweg, N., Meier, P., Unterlauft, J. D., Wiedemann, P., Hattenbach, L., Kakkassery, V., Ranjbar, M., Mohi, A., Grisanti, S., Bastron, I., Sarac, S., Kaskel-Paul, S., Stoffelns, B., Schuster, A., Pfeiffer, N., Schulze, S., Praskevas, A., Sekundo, W., Weigel, M., Thieme, H., Wolf, A., Vounotrypidis, E., Priglinger, S., Bechstein, L., Maier, M., Lohmann, C., Haritoglu, C., Alten, F., Eter, N., Klishko, V., Holland, U., Medra, A., Weber, A., Hoeh, H., Schmidbauer, J., RiveraGomez, C., Plantzas, K., Weiss, M., Hille, K., Hoehn, F., Schrader, M., Napholz, A., Tandogan, T., Walter, C., Zuehlsdorff-Uthke, M., Liekfeld, A., Blecha, C., Barth, T., Helbig, H., Juenemann, A., Decker, A., Kuehn, M., Ladewig, M., Lenhard, K., Lackner, B., Gekeler, F., Holzschuh, I., Boden, K. T., Szurmann, P., Faul, D., May-Endres, K., Press, U., Luttke, J., Ziemssen, F., Bartz-Schmidt, U., Cordes, J., Raber, F., Mikielewicz, M., Kammerer, J., Kupferschmid, S., Buchwald, H., Werner, J., Kampmeier, J., Bula, A., Krauss, P., Strzalkowski, P., Hillenkamp, J., Gabel-Pfisterer, A., Boehringer, D., Agostini, H., Fuest, M., Walter, P., Botros, Y., Mueller, A., Al-Ashi, N., Lenglinger, M., Mueller, B., Schoenfeld, S., Seibel, I., Joussen, A., Breuss, H., Kuchenbecker, J., Foerster, M. H., Berthold, A., Wirbelauer, C., Hofmayer, H., Wachtlin, J., Palka, K., Niemeyer, M., Walla, T., Pham, D., Aisenbrey, S., Tatsiou, A., Walch, A., Burk, R., Schultz, T., Tsiampalis, N., Rehmann, J., Sliwowska, U., Schojai, M., Schulze, K., Kamguia, N., Wirtz, C., Dick, B., Voelker, D., Wintergerst, M., Pfau, M., Melzer, C., Hoegen, D., Bosch, F., Andresen, J. C., Krohne, T., Holz, F., Kathke, M., Sturm, A., Noske, W., Huebner, T., Brandner, S., Feldmann, M., Morsek, J., Rainer, O., Bartsch, H., Ewald, K., Chankiewitz, E., Siegmund, T., Bohlen, A., Mohr, A., Hecker, J., Strassburger, P., Furashova, O., Engelmann, K., Krieb, A., Emmerich, K., Grajewski, L., Krause, L., Jabur, A., Ruediger, K., Lehmann, F., Sachs, H., Matthee, E., Steindorf, F., Schnitzler, C., Neumann, I., Korbmacher, J., Geerling, G., Doulgkeridis, J., Erhard, J., Dahms-Dowidat, K., Kotiasvili, T., Jagow, B. V., Lieder, A., Blum, M., Westerkemper, H., Boehm, M., Bornfeld, N., Bechrakis, N., Schultheiss, M., Scheider, A., Mueller, M., Kohnen, T., Eckert, T., Eckardt, C., Wisniewska, M., Just, A., Jehle, V., Reinhard, T., Seewald, J., Mais, C., Basiakos, S., Osman, B., Xanthopoulou, E., Friedburg, B., Graef, M., Lorenz, B., Just, U., Naxer, S., Oterendorp, C., Bemme, S., Callizo, J., Feltgen, N., Hoerauf, H., Menges, A., Tost, F., Stahl, A., Huth, A., Viestenz, A., Bertram, P., Skevas, C., Kromer, R., Casagrande, M., Grohmann, C., Mehlan, J., Schindler, P., Spitzer, M., Schargus, M., Eddy, M., Schumacher, S., Keserue, M., Scheler, A., Stemplewitz, B., Schaudig, U., Abou Moulig, W., Framme, C., Rosenthal, A., Hesse, L., Kunz, L., Spira, C., Suffo, S., Seitz, B., Wietstock, G., Augsten, R., Meller, D., Mayer, M., Vanselow, K., Lieb, W., Beutner, A., Effert, R., Ehlken, C., Roider, J., Hueber, A., Cursiefen, K., Schrage, N., Kroeger, M., Viehweg, N., Meier, P., Unterlauft, J. D., Wiedemann, P., Hattenbach, L., Kakkassery, V., Ranjbar, M., Mohi, A., Grisanti, S., Bastron, I., Sarac, S., Kaskel-Paul, S., Stoffelns, B., Schuster, A., Pfeiffer, N., Schulze, S., Praskevas, A., Sekundo, W., Weigel, M., Thieme, H., Wolf, A., Vounotrypidis, E., Priglinger, S., Bechstein, L., Maier, M., Lohmann, C., Haritoglu, C., Alten, F., Eter, N., Klishko, V., Holland, U., Medra, A., Weber, A., Hoeh, H., Schmidbauer, J., RiveraGomez, C., Plantzas, K., Weiss, M., Hille, K., Hoehn, F., Schrader, M., Napholz, A., Tandogan, T., Walter, C., Zuehlsdorff-Uthke, M., Liekfeld, A., Blecha, C., Barth, T., Helbig, H., Juenemann, A., Decker, A., Kuehn, M., Ladewig, M., Lenhard, K., Lackner, B., Gekeler, F., Holzschuh, I., Boden, K. T., Szurmann, P., Faul, D., May-Endres, K., Press, U., Luttke, J., Ziemssen, F., Bartz-Schmidt, U., Cordes, J., Raber, F., Mikielewicz, M., Kammerer, J., Kupferschmid, S., Buchwald, H., Werner, J., Kampmeier, J., Bula, A., Krauss, P., Strzalkowski, P., and Hillenkamp, J.

Abstract

Background On festive days worldwide eyes are severely injured by fireworks. The data on the number and severity are to date not registered in Germany. Objective How frequent are firework-induced injuries in Germany, who are the affected, how serious are the injuries, which forms of treatment are necessary and how frequent are accompanying injuries? Method A German nationwide online-based survey was carried out in all inpatient eye departments and data over the last 3 consecutive years were descriptively analyzed. Results From New Years Eve 2016/2017, when 41 eye departments sent in data, the participation could be increased to 51 eye departments in 2018/2019. More than one third (33-39%) of all 1356 patients over 3 years were minors, 60% were younger than 25 years old and roughly 60% of patients were injured as bystanders or in an unclear situation. In total 25% of all eye injuries were considered severe and required inpatient treatment. Accompanying injuries of the other eye, the face and hands were more frequent in minors than in adults. Eyeball ruptures were reported in 10 minors and 38 adults over the 3 years. Conclusion Particularly minors and bystanders need better protection.

Published
2019

2. Pandemiebedingtes Verkaufsverbot von Feuerwerkskörpern in Deutschland führt zu einer deutlichen Abnahme der Augenverletzungen

Author

Gabel-Pfisterer, Ameli, Böhringer, Daniel, Agostini, Hansjürgen, Feuerwerks-Verletzungen-Studiengruppe, Botros, Y., Krieb, A., Emmerich, K.-H., Grajewski, L., Krause, L., Hoa, D. Q., Yilmaz, S., Jabur, A., Rüdiger, K., Boeker, T., Rashitova, D., Eberlein, G., Lehmann, F., Sachs, H., Matthee, E., Pillunat, L., Juergens, L., Kaya, S., Guthoff, R., Steindorf, F., Korbmacher, J., Geerling, G., Märtz, J., Widder, R., Rössler, G., Iseed, A., Doulgkeridis, J., Erhard, J., Tomalla, M., von Jagow, B., Filev, F., Schill, S., Kotiasvili, T., Kojetinski, C., Flach, A., Zollfrank, C., Lieder, A., Blum, M., Tourtas, T., Knorr, H., Kruse, F., Freimuth, M., Dalbah, S., Sokolenko, E., Mueller, A., Rating, P., Kiefer, T., Book, B., Westerkemper, H., Böhm, M., Bornfeld, N., Bechrakis, N., Schultheiss, M., Scheider, A., Pawlowczicz, K., Hagenbusch, J., Müller, M., Kohnen, T., Ahdab, K., Eckert, T., Eckardt, C., Wisniewska, M., Just, A., Laich, Y., Stifter, J., Avar, M., Gritzka, M., Jehle, V., Reinhard, T., Rab, S., Seewald, J., Mais, C., Basiakos, S., Osman, B., Xanthopoulou, E., Friedburg, B., Graef, M. H., Dempe, C., Lorenz, B., Just, U., Schrecker, J., Klemming, J., Drüke, D., Bemmer, L., Weiß, S., Take, P., Nguyen-Höhl, A., Oterendorp, C., Al-Ashi, N., Feltgen, N., Hoerauf, H., Prusiecki, I., Elle, J., Gundel, B., Bender, M. C., Menges, A., Tost, F., Stahl, A., Wienrich, R., Breuß, H., Huth, A., Viestenz, A., Ueberschaar, J., Daehn, T., Brooks, U., Schindler, P., Bigdon, E., Bertram, P., Skevas, C., Kromer, R., Kuchenbecker, J., Casagrande, M., Grohmann, C., Mehlan, J., Spitzer, M., Schargus, M., Eddy, M., Schumacher, S., Keserü, M., Scheler, A., Foerster, M. H., Stemplewitz, B., Schaudig, U., Herden, J., Haar, M., Tode, B., Junker, B., Abou Mouli, W., Volkmann, I., Framme, C., Scheuerle, A., Seibel, I., Auerbach, M., Beisse, C., Rohrschneider, K., Auffahrt, G., Mala, N., Rosenthal, A., Hesse, L., Daas, L., Flockerzie, E., Suffo, S., Böker, A., Seitz, B., Chrisoglou, N., Wietstock, G., Augsten, R., Meller, D., Althauspetervari, I., Rudolph, O., Floeter, C., Beutner, A., Effert, R., Greve, D., Mayer, M., Vanselow, K., Lieb, W., Kandzia, C., Purtskhvanidze, K., Ehlken, C., Roider, J., Hueber, A., Cursiefen, K., Edelmann, C., Lenglinger, M., Schrage, N., Kroeger, M., Viehweg, N., Meier, P., Unterlauft, J. D., Wiedemann, P., Rehak, M., Ziemssen, F., Rommel, F., Sonntag, S., Müller, B., Prasuhn, M., Pawlik, V., Kakkassery, V., Ranjbar, M., Mohi, A., Grisanti, S., Bastron, I., Dindin-Sarac, S., Kaskel-Paul, S., Rawohl, J., Schönfeld, S., Hattenbach, L., Stoffelns, B., Schuster, A., Pfeiffer, N., Besgen, V., Schröder, F., Schulze, S., Weber, N., Sekundo, W., Schuart, C., Renieri, G., Weigel, M., Thieme, H., Hagenau, F., Wolf, A., Vounotrypidis, E., Priglinger, S., Penkava, J., Klein, J., Bechstein, L., Joussen, A., Maier, M., Lohmann, C., Haritoglu, C., Alten, F., Eter, N., Brinkmann, C., Alshikh, F., Klishko, V., Holland, U., Medra, A., Kolarov, D., Weber, A., Höh, H., Pielen, A., Zschockelt, T., Luciani, F., Schmidbauer, J., Horn, P., Kodomskoi, L., Kuempel, H., Schwarz, P., Rivera Gomez, C., Plantzas, K., Weiss, M., Hille, K., Esper, G., Mazko, K., Kolbeck, L., Malek, S., Kupper, P., Grafmueller, S., Puk, C., Schrader, S., Darawsha, R., Bellios, N., Wulff, V., Ghaffary, A., Ghoreishi, A., Höhn, F., Napholz, A., Tandogan, T., Schmidt, L., Berthold, A., Ilski, P., Trossowski, C., Zühlsdorff-Utke, M., Liekfeld, A., Winter, I., Böhm, A., Blecha, C., Barth, T., Helbig, H., Rusch, W., Wirbelauer, C., Noerenberg, A., Juenemann, A., Fuchsluger, T. A., Matar, C., Zuche, M., Roehrig, S., Decker, A., Kühn, M., Ladewig, M., Schmidt-Wetter, J., Hofmayer, H., Machulla, R., Boateng, A.-F., Dias Blak, M., Krawczyk, S., Lenhard, K., Lackner, B., Gekeler, F., Mamacek, D., Wocker, L., Holzschuh, I., Wachtlin, J., Boden, K. T., Szurmann, P., Faul, D., May-Endres, K., Press, U., Luttke, J., Wolfram, L., Reichel, F., Seitz, I., Bartz-Schmidt, U., Speidel, A., Cordes, J., Raber, F., Mikielewicz, M., Kammerer, J., Kupferschmid, S., Buchwald, H., Werner, J., Meyer, J. F., Kampmeier, J., Dithmar, S., Fischer, G., Pruefke, C., Bula, A., Krauß, P., Strzalkowski, P., Hillenkamp, J., Macher, T., Kuerten, D., Palka, K., Niemeyer, M., Walla, T., Pham, D., Aisenbrey, S., Rieck, P., Verbeck, J., Tatsiou, A., Walch, A., Burk, R., Fuest, M., Schnober, G., Elling, M., Schultz, T., Tsiampalis, N., Rehmann, J., Sliwowska, U., Schojai, M., Schulze, K., Kamguia, N., Wirtz, C., Walter, P., Dick, B., Bourauel, L., Schützeichel, F. M., Völcker, D., Wintergerst, M., Pfau, M., Melzer, C., Hoegen, D., Bosch, F., Andresen, J. C., Wanjek-Meyer, K., Krohne, T., Holz, F. G., Fries, U., Koch, M., Kwasnicki, A., Kathke, M., Noske, W., Sturm, A., Chankiewitz, E., Monastoriotis, S., Kohen, L., Kemper, O., Hübner, T., Feldmann, M., Morsek, J., Rainer, O., Bartsch, H., Ewald, K., Brandter, S., Cil, M. U., Hartmann, K., Siegmund, T., Bohlen, A., Mohr, A., Wienigk, A., Hecker, J., Smetana, P., Furashova, O., Engelmann, K., Shtaya, M., and Müller, A.-K.

Abstract

Die Ophthalmologie 119(12), 1257-1266 (2022). doi:10.1007/s00347-022-01778-1, Published by Springer Medizin, Berlin ; Heidelberg

Published
2022

3. Extraocular muscle ductions following nasal transposition of the split lateral rectus muscle.

Author

Oke I, Lorenz B, Basiakos S, Gokyigit B, Dodd MU, Laurent E, Sadiq MA, Goberville M, Elkamshoushy A, Tsai CB, Gravier N, Speeg-Schatz C, Shepherd JB, Saxena R, Soni A, Hunter DG, Shah AS, and Dagi LR

Subjects
Humans, Oculomotor Muscles surgery, Retrospective Studies, Eye Movements, Nose, Ophthalmologic Surgical Procedures, Oculomotor Nerve Diseases diagnosis, Oculomotor Nerve Diseases etiology, Oculomotor Nerve Diseases surgery, Strabismus surgery
Abstract

Objective: To quantify changes in ductions following nasal transposition of the split lateral rectus muscle (NTSLR) for treating third nerve palsy., Design: Retrospective cohort study., Participants: A single eye from each patient with third nerve palsy treated with NTSLR with ocular motility measurements., Methods: Observation of changes in pre- and postoperative ductions. Outcome measures including patient demographic and surgical factors associated with the ability to adduct beyond the midline after NTSLR were evaluated using multivariable logistic regression., Results: A total of 116 patients met the inclusion criteria for this study. The NTSLR significantly decreased abduction (median of 0 limitation [interquartile range (IQR), 0-0] prior to surgery to -4 [IQR, -4 to -3] after NTSLR; p < 0.001), with a corresponding improvement in adduction (median, -5 [IQR, -5 to -4] prior to surgery to -4 [IQR, -4 to -3] after NTSLR; p < 0.001). There was no change in median supraduction or infraduction after NTSLR (p > 0.05). The ability to adduct beyond the midline after NTSLR was demonstrated in 42% of patients. Although not statistically significant, a trend toward a postoperative ability to adduct beyond the midline was seen in patients who had concurrent superior oblique muscle tenotomy (odds ratio [OR] = 5.08; 95% CI, 0.91-40.9) or who were designated with partial rather than complete third nerve palsy (OR = 2.29; 95% CI, 0.82-6.70)., Conclusions: NTSLR improves the horizontal midline positioning of eyes with third nerve palsy. Most eyes lose the ability to abduct, but some regain a modest ability to adduct while vertical ductions remain unchanged., (Copyright © 2022 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Published
2023
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4. Aberrant regeneration in an international registry of patients with 3rd-nerve palsy.

Author

Oke I, Lorenz B, Basiakos S, Gokyigit B, Laurent E, Tsai CB, Orge F, Heidary G, Tjeerd de Faber J, Jeddawi L, Sadiq MA, Strominger M, Dodd MU, Shah AS, and Dagi LR

Abstract

Background/aims: To describe the patterns of pre-operative aberrant regeneration and motility outcomes reported in an international registry of patients with 3 rd -nerve palsy treated with nasal transposition of the split lateral rectus muscle (NTSLR)., Methods: This cross-sectional study used data from an international, multicentre registry of patients with 3 rd -nerve palsy treated with NTSLR. Patients with aberrant regeneration were identified, and patterns of innervation described. Demographics and postoperative success defined as horizontal alignment ≤15 PD were compared based on the presence, and type, of aberrant regeneration using Wilcoxon rank sum and Fisher's exact tests., Results: Aberrant regeneration was reported in 16% (21/129) of patients. Age at diagnosis, sex, and aetiology of palsy were not significantly associated with aberrant regeneration. Abnormal movements were triggered by adduction in 52% (11/21), infraduction in 23% (5/21), and supraduction in 23% (5/21) of cases. Presentation patterns involved rectus muscle innervation in 29% (6/21) and levator muscle innervation in 71% (15/21) of cases. Although patients with aberrant regeneration had similar probability of success in comparison to those without following NTLSR (76% vs. 69%, p = 0.5), those with abnormal innervation of a rectus muscle had a lower success rate than those with abnormal innervation of the levator palpebrae superioris muscle (17% vs. 93%; p = 0.002)., Conclusion: Successful treatment of a 3 rd nerve palsy with NTSLR was not influenced by aberrant regeneration involving the levator muscle. Alternative surgical interventions should be considered when aberrant regeneration alters rectus muscle function given its adverse impact on motor outcomes with NTSLR., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Shah – Medtronic (Stock interest); Rebion, Inc. (Royalties); Pfizer, Inc. (Stock interest). Dagi – Honoraria for speaking at academic centres: Texas Children's Hospital, Canadian Ophthalmological Society, UCSF Department of Ophthalmology, Kellogg Eye Centre where early data were discussed.

Published
2023
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5. Worldwide outcomes of nasal transposition of the split lateral rectus muscle for strabismus associated with 3rd-nerve palsy.

Author

Shah AS, Dodd MU, Gokyigit B, Lorenz B, Laurent E, Sadiq MAA, Tsai CB, Gravier N, Goberville M, Basiakos S, Zurakowski D, and Dagi LR

Subjects
Humans, Adult, Oculomotor Muscles surgery, Paralysis complications, Paralysis surgery, Ophthalmologic Surgical Procedures methods, Retrospective Studies, Treatment Outcome, Vision, Binocular, Oculomotor Nerve Diseases etiology, Oculomotor Nerve Diseases surgery, Strabismus etiology, Strabismus surgery, Exotropia surgery
Abstract

Background/aims: To determine success rate and complications associated with nasal transposition of the split lateral rectus muscle (NTSLR) for treating strabismus from 3rd-nerve palsy., Methods: An international, multicentre, registry of patients with unilateral 3rd-nerve palsy treated with NTSLR was created. Patients with concurrent surgery on the contralateral eye were excluded. Primary outcome was horizontal alignment within 15 prism dioptres (PD) of orthotropia. Incidence of technical difficulties and vision-threatening complications by 6 months post-procedure were reported., Results: Ninety-eight patients met inclusion criteria. Median age was 33.5 years (IQR 10.75-46). Aetiologies included congenital (31%), neoplastic (16%) and traumatic (15%). Twenty-five per cent of patients had prior ipsilateral strabismus surgery. Median exotropia decreased from 70PD preoperatively (IQR 50-90) to 1PD postoperatively (IQR 0-15.5), with a success rate of 69%. Performing concurrent superior oblique muscle tenotomy (SOT) was independently associated with success (p=0.001). Technical challenges occurred in 30% of cases, independently associated with a history of ipsilateral strabismus surgery (p=0.01). Eleven per cent of patients had vision-threatening complications, independently associated with more posterior placement of the split lateral rectus (LR) muscle (p<0.001), and most commonly transient serous choroidal effusion. Surgical placement of the split LR muscle within 4.25 mm of the medial rectus (MR) muscle insertion reduced this risk., Conclusion: NTSLR significantly improved primary position alignment altered by 3rd-nerve palsy. Concurrent SOT and placement of the split LR muscle ≤4.25 mm posterior to the MR muscle insertion optimised outcomes. NTSLR proved technically challenging when prior ipsilateral strabismus surgery had been performed., Competing Interests: Competing interests: ASS: Medtronic (Stock interest); Rebion (Royalties); Pfizer (Stock interest). LRD: honoraria for speaking at academic centres: Texas Children’s Hospital, Canadian Ophthalmological Society, UCSF Department of Ophthalmology, Kellogg Eye Center where early data were discussed, Pfizer (Stock interest)., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Published
2023
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6. Nasal Transposition of the Split Lateral Rectus Muscle for Strabismus Associated With Bilateral 3 rd -Nerve Palsy.

Author

Oke I, Lorenz B, Basiakos S, Gokyigit B, Dodd MU, Laurent E, Hunter DG, Goberville M, Elkamshoushy A, Tsai CB, Orge F, Velez FG, Jeddawi L, Gravier N, Li N, Shah AS, and Dagi LR

Subjects
Adult, Follow-Up Studies, Humans, Middle Aged, Oculomotor Muscles surgery, Ophthalmologic Surgical Procedures methods, Paralysis surgery, Retrospective Studies, Treatment Outcome, Vision, Binocular physiology, Exotropia surgery, Strabismus etiology, Strabismus surgery
Abstract

Purpose: To determine the success rate and complications associated with nasal transposition of the split lateral rectus muscle (NTSLR) for treating bilateral 3 rd -nerve palsy., Design: Retrospective, interventional case series., Methods: An international, multicenter registry was used for the study. The study population was all patients with bilateral 3 rd -nerve palsy treated with NTSLR. Sensorimotor evaluations were conducted before and 6 months after unilateral or bilateral NTSLR. Outcome measures were postoperative horizontal alignment ≤15 prism diopters (PD), intraoperative technical difficulties, and vision-threatening complications. The association of patient demographics and surgical technique with each outcome was analyzed using multivariable logistic regression., Results: A total of 34 patients were included, with a median age of 46 years (interquartile range [IQR] = 25-54 years) at surgery. The most common etiologies were ischemic (29%), neoplastic (15%), and congenital (12%). NTSLR performed unilaterally with alternative surgery on the opposite eye (65%) resulted in a median postoperative exotropia of 18 PD (IQR = 7-35 PD), and when performed bilaterally (35%) resulted in postoperative exotropia of 14 PD (IQR = 5-35 PD). Success was achieved in 50% of cases, intraoperative technical difficulties were reported in 18%, and vision-threatening complications occurred in 21%. Attachment of the lateral rectus muscle ≥10 mm posterior to the medial rectus insertion was associated with increased vision-threatening complications (odds ratio = 9.0; 95% CI = 1.3-99)., Conclusions: NTSLR can address the large-angle exotropia associated with bilateral 3rd-nerve palsy. Surgeons should be aware that posterior placement of the lateral rectus muscle may increase the risk of vision-threatening complications, particularly serous choroidal effusion., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Published
2022
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7. Splitting of the lateral rectus muscle with medial transposition to treat oculomotor palsy: a retrospective analysis of 29 consecutive cases.

Author

Basiakos S, Gräf M, Preising MN, and Lorenz B

Subjects
Adolescent, Adult, Aged, Child, Child, Preschool, Female, Follow-Up Studies, Humans, Male, Middle Aged, Oculomotor Muscles physiopathology, Oculomotor Nerve Diseases complications, Oculomotor Nerve Diseases physiopathology, Retrospective Studies, Strabismus etiology, Strabismus physiopathology, Treatment Outcome, Young Adult, Eye Movements physiology, Oculomotor Muscles surgery, Oculomotor Nerve Diseases surgery, Ophthalmologic Surgical Procedures methods, Strabismus surgery, Vision, Binocular physiology
Abstract

Purpose: The lateralis splitting technique has been an interesting option for treating large-angle exotropia due to complete 3rd nerve paralysis since its inception in the early 1990s. The purpose of this study is to report on our experience regarding the effectiveness and complications of this method., Methods: Retrospective analysis of a consecutive series of 29 patients operated by one single experienced surgeon and examined according to a specific operative and perioperative protocol. Patients were examined preoperatively, on the 2nd day and 3rd month after surgery. Outcome measures include strabismus angle, horizontal motility, head turn, binocular function, and incidence and resolution of postoperative serous retinal detachment as seen with infrared imaging and spectral domain optical coherence tomography (SD-OCT)., Results: Surgery brought about a large and stable reduction of strabismus angle and head turn. It reduced horizontal motility, but moved the range of monocular excursion much closer to center. Eighty percent of patients with constant diplopia acquired some fields of single binocular vision. A significant number of cases (33.3%) developed transitory serous retinal detachment with varying onset and extent., Conclusion: This is by far the largest published study regarding the outcome of lateralis splitting in NIII palsy. The procedure is difficult, yet a very useful option. Serous detachment is a serious complication, but usually transitory. Its cause and mechanisms are not fully understood and warrant further investigation.

Published
2019
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