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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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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.
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.
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.
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.
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