Transposition surgery for internuclear ophthalmoplegia.

PURPOSE: To report outcomes of an extraocular muscle transposition procedure for surgical correction of internuclear ophthalmoplegia.

METHODS

Records of patients operated on between January 1999 and May 2011 were reviewed to identify patients treated with an extraocular muscle transposition procedure for internuclear ophthalmoplegia. Indications for this procedure included a known unilateral or bilateral internuclear ophthalmoplegia with a large-angle exotropia, a moderate adduction limitation, and a large-angle exodeviation in primary position. All patients underwent orthoptic evaluation preoperatively and postoperatively. Examination included assessment of subjective complaints, visual acuity, deviation in diagnostic positions of gaze, and limitation of ocular motility.

RESULTS

Five patients were identified. The mean reduction in exodeviation at distance after surgery was 59 ± 25 prism diopters, giving a mean percent reduction in exodeviation of 99.6% ± 0.1%. Four of five patients achieved primary position orthotropia at distance; the remaining patient had 2 prism diopters of exodeviation. One patient who had a residual exodeviation after the initial transposition procedure did not have accompanying ipsilateral lateral rectus recession, but achieved orthotropia with a subsequent ipsilateral lateral rectus recession.

CONCLUSION

Transposition surgery is an effective option for surgical treatment of patients with internuclear ophthalmoplegia with exodeviation and diplopia when combined with ipsilateral lateral rectus recession.