Augmented superior rectus transposition with medial rectus recession in patients with abducens nerve palsy

To evaluate the surgical outcome of augmented superior rectus transposition (SRT) and medial rectus recession (MRc) in patients with abducens nerve palsy.

The medical records of consecutive patients with abducens nerve palsy who underwent unilateral or bilateral simultaneous SRT with MRc from January 2012 to December 2014 were analyzed. Patients with previous strabismus surgery or botulinum toxin injection were excluded. Primary outcome measures were esotropia in primary position and abduction deficit. Data collected included age, sex, etiology, pre- and postoperative deviation, pre- and postoperative abduction deficit, anomalous head posture, induced vertical or torsional deviations postoperatively, reoperations, and details of other complications. Success was defined as postoperative alignment within 10^Δ of orthotropia; failure, as residual esotropia of ≥20^Δ.

A total of 15 eyes of 13 patients were included. The most common cause of abducens nerve palsy was trauma (10 patients). The mean preoperative esotropia was 55.4^Δ ± 24^Δ, which improved postoperatively to 9.9^Δ ±10^Δ (P = 0.0000). The mean preoperative abduction deficit was -5 units, decreasing postoperatively to -3.1 (P = 0.000). Nine patients (69%) achieved success; 2 were classified as failures. One patient each developed postoperative hypotropia and intorsion; however, these were transient and did not require additional procedures. No patients developed anterior segment ischemia.

Augmented SRT with MRc is effective in the management of abducens nerve palsy; however, its success in large deviations remains variable. Long-term follow-up is essential to determine the incidence of vertical and torsional deviations.