Double Augmented Vertical Rectus Transposition for Large-Angle Esotropia Due to Sixth Nerve Palsy

Area of Science:

• Ophthalmology
• Strabismus Surgery
• Neuro-ophthalmology

Background:

• Sixth nerve palsy can cause significant esotropia, impacting binocular vision and potentially leading to compensatory head postures.
• Non-resolving sixth nerve palsy requires effective surgical interventions to restore ocular alignment and function.

Purpose of the Study:

• To evaluate the efficacy of the double augmented Hummelsheim procedure, a type of vertical recti transposition, in managing large-angle esotropia secondary to sixth nerve palsy.
• To assess improvements in binocular alignment, ocular motility, and visual field function post-surgery.

Main Methods:

• A prospective interventional study included fifteen patients with non-resolving sixth nerve palsy.
• Surgical intervention involved the double augmented Hummelsheim procedure, often combined with medial rectus recession.
• Outcomes analyzed included horizontal and vertical deviations, ocular motility, head posture, and the field of diplopia-free single vision.

Main Results:

• The procedure significantly reduced mean primary esotropia from 58.3 PD to 7.2 PD (P = .001).
• Twenty percent of patients had residual deviation >10 PD; one required prism treatment for diplopia.
• Improved head posture and a widened diplopia-free visual field were observed in most patients.

Conclusions:

• Double augmentation of the Hummelsheim procedure combined with medial rectus recession is effective in reducing esotropia and enhancing the diplopia-free visual field.
• This surgical technique offers a viable option for patients with large-angle esotropia due to sixth nerve palsy.