title: Outcomes After Superior Rectus Transposition and Medial Rectus Recession Versus Vertical Recti Transposition for Sixth Nerve Palsy.
abstract: OBJECTIVE
  To compare the effectiveness of superior rectus transposition and medial rectus recession (SRT/MRc) vs inferior and superior rectus transposition (VRT) for acquired sixth nerve palsy.
  
  
  METHODS
  Consecutive, interventional case series.
  
  
  METHODS
  The medical records of a consecutive series of patients with acquired sixth nerve palsy who underwent VRT or SRT/MRc by a single surgeon were reviewed. The preoperative and postoperative findings were compared between the 2 groups.
  
  
  RESULTS
  Eight patients (mean age, 46.8 years) underwent SRT/MRc and 8 patients underwent VRT (mean age, 51.1 years). Lateral fixation was performed on all but 4 patients in the VRT group. Preoperative esotropia in primary position and abduction deficit were similar in both groups (SRT/MRc, 41.9 prism diopter [PD], -4.6; VRT, 55.6 PD, -4.5; P = .195, 1.0). The SRT/MRc group underwent a mean MR recession of 6 (range, 5-7) mm. Four patients in the VRT later underwent MR recession (mean 5.3 mm, range 5-6 mm). In addition, 5 patients in the VRT group had 1 or more botulinum toxin injections in the medial rectus muscle. No additional procedures were performed in the SRT/MR group. Fewer additional procedures were performed with SRT/MR (SRT/MR, 0; VRT, 1.8 ± 1.2; P < .010). At last follow-up, residual esotropia (SRT/MRc, 7.1 PD; VRT, 10.3 PD; P = .442) was similar in both groups, but abduction was better in the SRT/MRc group (SRT/MR, -3.0 ± 0.7; VRT, -3.8 ± 0.4; P = .038). There were no new persistent vertical deviations or torsional diplopia.
  
  
  CONCLUSIONS
  Final outcomes were similar with SRT/MRc vs VRT. However, fewer additional surgical procedures were needed with SRT/MR.
authors.affiliation: Department of Ophthalmology, Chungnam National University Hospital, Daejeon, South Korea.
authors.forename: Yeon-Hee
authors.initials: YH
authors.lastname: Lee
authors.affiliation: Department of Ophthalmology, Stanford University School of Medicine, Stanford, California. Electronic address: lambert7@stanford.edu.
authors.forename: Scott R
authors.initials: SR
authors.lastname: Lambert
mesh_terms: D020434:Abducens Nerve Diseases / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004172:Diplopia / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D004948:Esotropia / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D005133:Eye Movements; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000503:physiopathology / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D015348:Vision, Binocular / Q000502:physiology*; D055815:Young Adult