title: Long-term results of vertical rectus muscle transposition and botulinum toxin for sixth nerve palsy.
abstract: OBJECTIVE
  To report the long-term outcome of full-tendon vertical rectus muscle transposition combined with chemodenervation of the ipsilateral medial rectus muscle for acquired chronic sixth (abducens) nerve palsy.
  
  
  METHODS
  A retrospective study of all patients treated for severe abduction deficit with transposition plus botulinum toxin over the course of 11 years. Minimum follow-up was 12 months. Main outcome measures were the surgical result and its stability.
  
  
  RESULTS
  A total of 22 patients were included. Mean age at the time of surgery was 41.7 ± 19.1 years (range, 4.5-69). The etiologies for the palsy were head trauma (11), tumor (10), and idiopathic (1). Mean follow-up time was 44.2 ± 37.4 months (range, 12-123). The average distance deviation was 38.1(Δ) ± 11.6(Δ) preoperatively, 4.0(Δ) ± 16.1(Δ) 3 months after the operation (p = 0.0004), and 7.9(Δ) ± 8.8(Δ) at 12 months (p = 0.0003), with no subsequent change. At the final examination, on average 44.2 months after the operation, 13 patients (59%) were within 10(Δ) of alignment, 2 (1%) were overcorrected, and 7 (32%) had vertical deviations. The majority of patients (73%) had no double vision in the primary position. No patient developed anterior segment ischemia.
  
  
  CONCLUSIONS
  Vertical rectus muscle transposition combined with intraoperative botulinum toxin injection into the ipsilateral medial rectus muscle improved alignment in patients with complete chronic sixth nerve palsy. While the effects of treatment may have diminished slightly during the first year after surgery, they remained stable thereafter.
authors.affiliation: Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel. leiba3@bezeqint.net
authors.forename: Hana
authors.initials: H
authors.lastname: Leiba
authors.forename: Gabriela M
authors.initials: GM
authors.lastname: Wirth
authors.forename: Christoph
authors.initials: C
authors.lastname: Amstutz
authors.forename: Klara
authors.initials: K
authors.lastname: Landau
mesh_terms: D020434:Abducens Nerve Diseases / Q000188:drug therapy* / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D018726:Anti-Dyskinesia Agents / Q000627:therapeutic use; D001905:Botulinum Toxins / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003131:Combined Modality Therapy; D004948:Esotropia / Q000188:drug therapy / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000601:surgery*; D012189:Retrospective Studies; D013710:Tendons / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D015348:Vision, Binocular; D055815:Young Adult
chemical_list: D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins