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Ahmed Soliman, Alejandra Decanini, Erick Bothun; A modified transposition technique of the superior and inferior rectus muscles in cases with longstanding sixth nerve palsy to reduce postoperative vertical deviation and torsion. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4708.
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Transposition of the vertical recti is frequently performed to help improve the ocular alignment for sixth nerve palsy. Asymmetric restriction of the transposed muscles may result in induced vertical or torsional deviation. We propose a modified technique that may reduce this complication and requires fewer scleral needle passes.
Temporal transposition of the vertical recti was performed for complete sixth nerve palsy. The nasal edge of both the superior and inferior rectus muscles were secured to the sclera adjacent to the corresponding side of lateral rectus insertion. The temporal edge of both vertical recti were tied together underneath the lateral rectus muscle without scleral attachment.
Three males and one female were included in this retrospective study. Mean distance esodeviation improved from 45 +/- 12.9 prism diopters (PD) preoperatively to 8.8 +/- 8 PD (P<.05). Mean near esodeviation improved from 45 +/- 24.8 to 13 +/- 7.7 PD (P<.05). Abduction deficit improved from -4 preoperatively to -2 postoperatively (P<.05). No vertical deviation or torsion was induced postoperatively.
1) Tying the temporal edges of the transposed recti together underneath the lateral rectus without scleral attachment allows for sliding of the superior-inferior rectus union to “self-adjust” up and down to relax or balance restriction. 2) This technique reduces the risk of globe perforation as it requires only two scleral needle passes. 3) The modified transposition technique appears effective in improving ocular alignment in patients with longstanding sixth nerve palsy without inducing a vertical or torsional deviation.
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