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Magnetic resonance imaging of bilateral split lateral rectus transposition to the medial globe

  • Neuro-ophthalmology
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

Medial transposition of the split or intact lateral rectus (LR) muscle in oculomotor palsy improves extreme exotropia. We studied rectus pulley positions using high-resolution surface coil MRI before and after LR split with medial transposition surgery in a patient with bilateral oculomotor and trochlear nerve palsies.

Methods

This is a report of a 14-year-old girl with 90Δ exotropia due to bilateral oculomotor and trochlear nerve palsies following traumatic midbrain infarction at age 6 years. Surgery comprised longitudinal division of each LR into a superior and inferior, threading of both halves between the inferior rectus (IR) and inferior oblique inferiorly, and inferior to the superior oblique and the superior rectus superiorly, with suturing of each 10 mm posterior to the medial rectus (MR) insertion.

Results

Pre-operative MRI of the orbit and extraocular muscles (EOMs) with thin, 2-mm slices revealed bilateral atrophy of all EOMs supplied by the oculomotor and trochlear nerves. Post-operative MRI at 2 months demonstrated no significant changes in rectus EOM pulley positions compared with pre-operative values.

Conclusions

The LR pulley does not change position even after split LR transposition to the MR insertion, confirming the profound constraint of the connective tissue pulley system on the LR path.

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Acknowledgments

All authors had full access to all the data in the study and take responsibility for the integrity of the data and accuracy of analysis. This study was supported by U.S. Public Health Service, NEI grant EY08313. Joseph L. Demer was also supported by Research to Prevent Blindness. Zia Chaudhuri was supported by the BOYSCAST Fellowship of the Department of Science and Technology, Government of India.

The authors thank Michael H. Graf, professor of strabismology and neuro-ophthalmology, Justus Liebig University, Giessen, Germany for sharing his experience with this procedure.

Conflict of interest

All authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Patient consent disclosure

The patient’s guardian (mother) has consented to the submission of the case report for submission to the journal. This submission does not have a photograph that identifies the patient.

Grant support

This study was supported by the US Public Health Service (PHS), National Eye Institute (NEI) Grant 08313 and Research to Prevent Blindness (RPB). Zia Chaudhuri’s work was supported by the BOYSCAST Fellowship of the Department of Science & Technology, Government of India.

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Authors and Affiliations

  1. Stein Eye Institute, University of California Los Angeles (UCLA), 100 Stein Plaza, Los Angeles, CA, 90095-7002, USA

    Zia Chaudhuri & Joseph L. Demer

  2. Department of Ophthalmology, University of California Los Angeles (UCLA), Los Angeles, CA, USA

    Zia Chaudhuri & Joseph L. Demer

  3. Department of Neurology, University of California Los Angeles (UCLA), Los Angeles, CA, USA

    Joseph L. Demer

  4. Neuroscience Interdepartmental Program, University of California Los Angeles (UCLA), Los Angeles, CA, USA

    Joseph L. Demer

  5. Bioengineering Interdepartmental Program, University of California Los Angeles (UCLA), Los Angeles, CA, USA

    Joseph L. Demer

Authors
  1. Zia Chaudhuri
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  2. Joseph L. Demer
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Corresponding author

Correspondence to Joseph L. Demer.

Additional information

Study conducted at the Stein Eye Institute, University of California Los Angeles (UCLA), Los Angeles, CA, United States of America

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Chaudhuri, Z., Demer, J.L. Magnetic resonance imaging of bilateral split lateral rectus transposition to the medial globe. Graefes Arch Clin Exp Ophthalmol 253, 1587–1590 (2015). https://doi.org/10.1007/s00417-015-3071-6

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  • DOI: https://doi.org/10.1007/s00417-015-3071-6

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