@article {1645484,
	title = {Nasal Transposition of the Split Lateral Rectus Muscle for Strabismus Associated With Bilateral 3rd-Nerve Palsy},
	journal = {Am J Ophthalmol},
	volume = {242},
	year = {2022},
	month = {2022 Oct},
	pages = {165-172},
	abstract = {PURPOSE: To determine the success rate and complications associated with nasal transposition of the split lateral rectus muscle (NTSLR) for treating bilateral 3rd-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 3rd-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]\&nbsp;=\&nbsp;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\&nbsp;=\&nbsp;7-35 PD), and when performed bilaterally (35\%) resulted in postoperative exotropia of 14 PD (IQR\&nbsp;=\&nbsp;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\&nbsp;=\&nbsp;9.0; 95\% CI\&nbsp;=\&nbsp;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.},
	keywords = {Adult, Exotropia, Follow-Up Studies, Humans, Middle Aged, Oculomotor Muscles, Ophthalmologic Surgical Procedures, Paralysis, Retrospective Studies, Strabismus, Treatment Outcome, Vision, Binocular},
	issn = {1879-1891},
	doi = {10.1016/j.ajo.2022.06.010},
	author = {Oke, Isdin and Lorenz, Birgit and Basiakos, Sotirios and Gokyigit, Birsen and Ugo Dodd, Mary-Magdalene and Laurent, Erick and Hunter, David G and Goberville, Mitra and Elkamshoushy, Amr and Tsai, Chong-Bin and Orge, Faruk and Velez, Federico G and Jeddawi, Laila and Gravier, Nicholas and Li, Ningdong and Shah, Ankoor S and Dagi, Linda R and NTSLR3NP Study Group}
}
