April 2011
Volume 52, Issue 14
Free
ARVO Annual Meeting Abstract  |   April 2011
Incidence Of Induced Vertical Strabismus Following Horizontal Transposition Of Vertical Recti For Duane Syndrome And Sixth Nerve Palsy
Author Affiliations & Notes
  • Alinda G. McGowin
    Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, Tennessee
  • Mary E. Hoehn
    Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, Tennessee
  • Natalie C. Kerr
    Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, Tennessee
  • Footnotes
    Commercial Relationships  Alinda G. McGowin, None; Mary E. Hoehn, None; Natalie C. Kerr, None
  • Footnotes
    Support  RPB (unrestricted grant to Hamilton Eye Institute)
Investigative Ophthalmology & Visual Science April 2011, Vol.52, 6365. doi:
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      Alinda G. McGowin, Mary E. Hoehn, Natalie C. Kerr; Incidence Of Induced Vertical Strabismus Following Horizontal Transposition Of Vertical Recti For Duane Syndrome And Sixth Nerve Palsy. Invest. Ophthalmol. Vis. Sci. 2011;52(14):6365.

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Abstract

Purpose: : Horizontal transposition of vertical recti augmented with posterior fixation sutures is a surgical technique used to treat abduction deficiency in Duane syndrome and sixth nerve palsy. Vertical strabismus can be induced, and the incidence has been reported in the range of 8.5-30%, and may result in adverse outcomes such as persistent diplopia and need for further surgery.

Methods: : We performed a retrospective chart review. Nineteen patients with Duane syndrome or sixth nerve palsy and esotropia with abduction deficiency had surgical intervention and adequate follow-up for the study. All patients had vertical rectus muscle transpositions augmented with posterior fixation sutures with no other previous or concomitant vertical strabismus surgery. One patient had bilateral transpositions.

Results: : Preoperative esotropia averaged 34 prism diopters (PD) (range, 15-80PD). Postoperative esotropia was reduced to 7.9PD (range, 20PD XT - 45PD ET) at the 2 month follow-up visit. One of 19 patients (5%) developed a new vertical deviation postoperatively that required additional vertical strabismus surgery. Follow-up averaged 20 months (range, 2-106 months). Two patients had a vertical deviation of 4PD at 2 months which resolved by last follow-up visit without surgical intervention. Two patients with Duane syndrome not included in the study had vertical deviations preoperatively (one had inadequate follow-up and the other had concomitant vertical rectus resection). Both of these patients were found to have persistent vertical deviations postoperatively which were similar to preoperative measurements.

Conclusions: : Vertical rectus transposition augmented with Foster posterior fixation suture is an effective treatment for esotropia with abduction deficiency in Duane syndrome and sixth nerve palsy. We found a low incidence of induced vertical strabismus postoperatively. Reviewing our series, we conclude that careful preoperative measurements prior to transposition surgery may identify pre-existing vertical deviations that may persist after surgery but are not the result of the surgical procedure.

Keywords: strabismus: treatment 
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