Surgical Results of a Muscle Transposition Procedure for Abducens Palsy Without Tenotomy and Muscle Splitting

PurposeTo report a simple muscle transposition procedure without tenotomy or muscle splitting to treat abducens palsy.DesignRetrospective, interventional, consecutive case series.MethodsNine patients with esotropia resulting from abducens palsy whose eyes could not abduct beyond the midline underwent this muscle transposition procedure, in which a suture was inserted through the temporal margin of each vertical rectus muscle. The same monofilament suture also was inserted into each inferotemporal or superotemporal sclera. The lateral margin of each vertical rectus muscle was transposed superotemporally or inferotemporally and was sutured onto the sclera. All 9 patients underwent unilateral muscle transposition, and 6 of the 9 underwent a medial rectus muscle recession combined with muscle transposition in the same eye.ResultsThe surgical correction by muscle transposition alone ranged from 24 to 36 prism diopters, and that by muscle transposition and recession of the medial rectus muscle ranged from 50 to 62 prism diopters. The mean correction was 46.3 ± 13.1 prism diopters per eye. All paretic eyes could abduct beyond the midline. No major vertical ductional disturbances developed. Anterior segment ischemia did not occur in any patients.ConclusionsThis procedure, which achieved the same corrective results as other popular procedures, is simple to perform because it requires only a suture from the muscle to sclera. Tenotomy or splitting of the transposed muscles is unnecessary.