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Unaugmented vertical muscle transposition surgery for chronic sixth nerve paralysis
Shveta Bansal1, Javeed Khan, Ian B Marsh
1Department of Ophthalmology, Royal Liverpool University Hospital, Liverpool, UK. shveta@dr.com
Strabismus
|December 13, 2006
Summary
Unaugmented vertical rectus transposition effectively treats chronic sixth nerve palsy, significantly reducing eye deviation and diplopia. This surgical approach may eliminate the need for costly botulinum toxin injections, with few patients requiring further medial rectus surgery.
Area of Science:
- Ophthalmology
- Strabismus Surgery
- Neuro-ophthalmology
Background:
- Chronic sixth nerve palsy often leads to debilitating diplopia.
- Vertical muscle transposition surgery is a common treatment.
- Augmentations like medial rectus recession or botulinum toxin increase complication risks.
Purpose of the Study:
- To assess the efficacy and safety of unaugmented full-tendon vertical rectus transposition.
- To evaluate this technique in patients with chronic sixth nerve paralysis.
Main Methods:
- A longitudinal study of 21 patients with chronic sixth nerve palsy (>6 months).
- Patients underwent superior and inferior recti transposition without medial rectus recession or botulinum toxin.
- Preoperative and postoperative orthoptic examinations were analyzed.
Main Results:
- Mean esotropia in primary position significantly reduced from 46.7 PD to 14.6 PD (p < 0.001).
- 55.6% achieved orthophoria within 10 PD without diplopia.
- 28.6% required subsequent medial rectus recessions; 4.2% experienced inferior rectus slippage.
Conclusions:
- Unaugmented vertical rectus transposition is effective for chronic sixth nerve palsy.
- Botulinum toxin may be unnecessary, reducing patient costs and interventions.
- Medial rectus recession is infrequently required as a secondary procedure.
