The efficacy of vertical rectus transposition and its modalities in patients with abducens nerve palsy.
OBJECTIVE
Patients with VIth nerve palsy that does not resolve within 6 months should undergo surgery. The most common procedure used in such cases is transposition of a whole or a part of a vertical rectus muscle combined or not with a resection of the lateral rectus muscle. Commonly, a simultaneous recession of medial rectus muscle with or without prior injection of botulinum toxin is performed. The aim of our study was to evaluate the results of vertical rectus transposition performed in patients with abducens nerve palsy.


METHODS
Nine cases of abducens nerve palsy ware retrospectively analyzed. All patients underwent full ophthalmic and orthoptic examination before and after surgery. All patients underwent vertical rectus muscle transposition to the lateral rectus insertion in the affected eye. Additional procedures included Jensen procedure, botulinum toxin injection, resection of the lateral rectus, recession of the medial rectus on the same side with or without adjustable sutures, and Foster modification of lateral rectus posterior fixation.


RESULTS
In all cases, we found a varying degree of postoperative improvement. There was a significant reduction in the strabismus angle for distance and near, increase in abduction of the affected eye, and broadening of the field of binocular single vision.


CONCLUSIONS
The vertical rectus muscle transposition technique is a safe and successful method of treatment in abducens nerve palsy. Its use together with additional procedures and modifications allows one to achieve orthophoria, improvement of abduction, and larger field of binocular single vision.
Nowakowska
Olimpia
O
Department of Ophthalmology, Medical University of Lodz, Lodz, Poland. o.m.nowakowscy@neostrada.pl
Loba
Piotr
P
Broniarczyk-Loba
Anna
A
D020434:Abducens Nerve Diseases / Q000601:surgery*; D000328:Adult; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage; D009801:Oculomotor Muscles / Q000637:transplantation*; D013508:Ophthalmologic Surgical Procedures; D012189:Retrospective Studies; D013285:Strabismus / Q000601:surgery; D013536:Suture Techniques; D016896:Treatment Outcome; D015348:Vision, Binocular / Q000502:physiology
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A