title: Adjustable augmented rectus muscle transposition surgery with or without ciliary vessel sparing for abduction deficiencies.
abstract: BACKGROUND
  Vertical rectus transposition (VRT) is useful in abduction deficiencies. Posterior fixation sutures enhance the effect of VRT, but usually preclude the use of adjustable sutures. Augmentation of VRT by resection of the transposed muscles allows for an adjustable technique that can reduce induced vertical deviations and overcorrections.
  
  
  METHODS
  We retrospectively reviewed the records of all patients undergoing adjustable partial or full tendon VRT augmented by resection of the transposed muscles. Ciliary vessels were preserved in most of the patients by either splitting the transposed muscle or by dragging the transposed muscle without disrupting the muscle insertion.
  
  
  RESULTS
  Seven patients with abducens palsy and one with esotropic Duane syndrome were included. Both vertical rectus muscles were symmetrically resected by 3-5 mm. Preoperative central gaze esotropia of 30.6 ± 12.9Δ (range, 17-50Δ) decreased to 10.6 ± 8.8Δ (range, 0-25Δ) at the final visit (p = 0.003). Three patients required postoperative adjustment by recession of one of the transposed muscles due to an induced vertical deviation (mean 9.3Δ reduced to 0Δ), coupled with overcorrection (mean exotropia 11.3Δ reduced to 0 in two patients and exophoria 2Δ in one patient). At the final follow-up visit 3.8 ± 2.6 months postoperatively, one patient had a vertical deviation <4Δ, and none had overcorrection or anterior segment ischemia. Three patients required further surgery for recurrent esotropia.
  
  
  CONCLUSIONS
  Augmentation of VRT by resection of the transposed muscles can be performed with adjustable sutures and vessel-sparing technique. This allows for postoperative control of overcorrections and induced vertical deviations as well as less risk of anterior segment ischemia.
authors.affiliation: Department of Ophthalmology, Jules Stein Eye Institute, University of California , Los Angeles , California .
authors.forename: Karen
authors.initials: K
authors.lastname: Hendler
authors.forename: Stacy L
authors.initials: SL
authors.lastname: Pineles
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Demer
authors.forename: Dawn
authors.initials: D
authors.lastname: Yang
authors.forename: Federico G
authors.initials: FG
authors.lastname: Velez
mesh_terms: D000328:Adult; D000368:Aged; D004370:Duane Retraction Syndrome / Q000503:physiopathology / Q000601:surgery*; D005133:Eye Movements / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000503:physiopathology / Q000601:surgery*; D011184:Postoperative Period; D012189:Retrospective Studies; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures
keywords: Adjustable; augmented; esotropia; transposition; vessel-sparing
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