Dual-Augmented Transposition of Vertical Recti in Chronic Abducens Palsy

To report the results of dual augmentation of vertical rectus muscle transposition (VRT) in the treatment of chronic sixth nerve palsy.

Retrospective case series.

This is a retrospective review of medical records of patients with chronic sixth nerve palsy who underwent dual augmented VRT with or without medial rectus (MR) recession from 2013 to 2016. Data collection included sex, age, laterality, and duration of postoperative follow-up. Pre- and postoperative limitation of abduction and adduction were recorded using a 6-point scale. Improvement of esotropia in prism diopter (PD), head turn in degrees, and limitation of abduction and adduction were reported and analyzed.

Fourteen cases were identified. Mean patients' age at the time of surgery was 22.5 years. Postoperatively, esotropia and head turn were corrected by a mean of 31.3 PD and 18.2 degrees, respectively. Limited abduction was improved from -4.3 to -1.6, while in cases that underwent MR recession, adduction declined from 0.4 to -0.3. Postoperative induced small-amplitude hypertropia was reported in 3 cases.

Dual augmented VRT was effective in controlling esotropia, head turn, and limited abduction associated with chronic sixth nerve palsy with low rate of induced vertical deviation. Combined MR recession carries a risk of induced limitation of adduction.