Outcomes of three different vertical rectus muscle transposition procedures for complete abducens nerve palsy

PurposeTo compare the efficacy of three different vertical rectus muscle transposition (VRT) techniques performed as a sole procedure to correct ocular alignment and improve abduction in cases of complete abducens nerve palsy.MethodsThe medical records of patients with complete abducens nerve palsy who underwent one of three different VRT procedures without simultaneous medial rectus weakening over a period of 20 years were retrospectively reviewed. The following procedures were used: full-tendon transposition (FTT), FTT with 4 mm resections before reinsertion (FTTR), and FTT with myopexy sutures (FTTM). We recorded the pre- and postoperative alignments, limitations of adduction and abduction, and complications. Follow-up was at least 6 months.ResultsA total of 26 patients (age range, 8-74 years) were included: 25 unilateral and 1 bilateral. Follow-up ranged from 6 to 21 months. Among 25 patients having unilateral surgery, the mean changes in esotropia were: 36.0Δ for FTT (n = 9), 46.4Δ for FTTR (n = 7), and 41.3Δ for FTTM (n = 9). Mean improvements in abduction grading were 0.94 for FTT (9 eyes), 1.64 for FTTR (7 eyes), and 1.41 for FTTM (11 eyes). For both measures the means were not significantly different. Three patients (2 FTT and 1 FTTM) had new postoperative vertical tropias >3Δ. Only 1 patient (with FTTR) had an overcorrection.ConclusionsFTTR corrected the most esotropia and improved abduction to the greatest degree, with the advantages of a low risk of creating a new vertical deviation and avoiding the risks of extra scleral sutures.