Augmented vertical rectus transposition surgery with single posterior fixation suture: Modification of Foster technique

PurposeTo describe a modification of the lateral posterior fixation augmentation suture of the vertical rectus muscles that is proposed to enhance the abducting vector while balancing the vertical vectors, therefore limiting stress on the sclera and preventing vertical deviations.MethodsFull tendon temporal transposition of the vertical rectus muscles was performed on 5 patients with Duane retraction syndrome and 5 with sixth (abducens) nerve palsy. Augmentation was created by the use of a single lateral fixation suture of 5–0 polyester that incorporated the muscle bellies of both vertical muscles. The lateral rectus muscle was disinserted and attached to the lateral orbital wall in 4 of the patients with Duane syndrome.ResultsFour of 5 patients with Duane syndrome and 4 of 5 patients with abducens nerve palsy had successful horizontal alignment, defined as reduction or elimination of head turn, a deviation ≤10Δ, and resolution of diplopia. Patients with Duane syndrome had improved adduction, elimination of co-contraction, and decreased torticollis. Patients with abducens nerve palsy were noted to have a reduction of esotropia with improved abduction.ConclusionsThe modified technique limits stress on the scleral portion of the lateral fixation suture; the opposing vertical vectors are transmitted to the opposite vertical rectus muscle. Patients exhibited improved abduction, adduction, torticollis, and range of single binocular vision with a low risk of vertical deviations induced by surgery. Complications included repeat strabismus surgery (2 cases) and scleral perforation (1 case). A vertical deviation of 3Δ developed in 1 patient.