Vertical rectus transposition procedures for lateral rectus palsy: A systematic review.

Area of Science:

• Ophthalmology
• Strabismus Surgery
• Oculomotor Neuroscience

Background:

• Lateral rectus palsy, often caused by abducens nerve palsy, significantly impacts binocular vision.
• Various surgical transposition techniques exist for managing lateral rectus palsy, but their comparative efficacy is not well-defined.
• Understanding the functional and anatomical outcomes of these procedures is crucial for optimal patient care.

Purpose of the Study:

• To systematically review and evaluate the functional and anatomical outcomes of vertical rectus transposition (VRT) surgery in patients diagnosed with lateral rectus palsy.
• To synthesize evidence from existing literature to clarify the indications and relative effectiveness of different VRT procedures.
• To identify gaps in the current research landscape regarding VRT for lateral rectus palsy.

Main Methods:

• A comprehensive systematic review was conducted, searching multiple electronic databases (MEDLINE, PubMed Central, EMBASE, Google Scholar, Scopus, Index Copernicus) without date restrictions.
• Search terms included variations of 'vertical rectus transposition' and 'lateral rectus palsy' or 'abducens palsy,' along with specific procedure names like 'Hummelsheim procedure.'
• Study selection and data extraction were performed independently by three authors, focusing on studies reporting outcomes for single and double VRT surgeries.

Main Results:

• Twenty-seven relevant studies were identified for inclusion in the review.
• The review included non-randomized studies due to the absence of available randomized controlled trials (RCTs) addressing the research question.
• Data synthesis focused on summarizing the functional and anatomical outcomes reported across the included non-randomized studies.

Conclusions:

• The current evidence base for vertical rectus transposition surgery in lateral rectus palsy relies on non-randomized studies, limiting definitive conclusions.
• There is a significant need for high-quality, prospective randomized controlled trials to rigorously compare the various transposition procedures.
• Future research should aim to elucidate the optimal indications and comparative effectiveness of different VRT techniques for managing lateral rectus palsy.