Unaugmented Vertical Muscle Transposition Surgery for Chronic Sixth Nerve Paralysis

Abstract

Botulinum toxin infiltration of the medial rectus in vertical rectus transposition surgery may be unnecessary, incurring cost, additional attendances and interventions for patients. Less than a third of all patients in our series required additional medial rectus recession later.

Augmented vertical recti transposition with intraoperative botulinum toxin for complete and chronic sixth nerve palsy

“…In previous studies that used unaugmented VRT with BTX, exotropic shift was between 32 and 66 PD, however, some authors have included patients with previous surgery. [4][5][6][7]12,13 In the current study, mean abduction deficit improved from − 4.4 to − 1.8, which seems to be slightly better than most of previously-mentioned transposition procedures. [4][5][6][7]11 Four (13.7%) of our patients were overcorrected.…”

Adjustable suture technique for enhanced transposition surgery for extraocular muscles

“…The incidence of induced vertical deviations of greater than 5 D in our study was 26.3%, which is in the range of previous studies (5% to 30%). 3,[7][8][9][10][11][12][13]19 We suspect that our routine use of vessel-sparing techniques in this surgery, with inclusion of a variable number of muscle fibers with the spared-vessel bundles, leads to many of these induced vertical deviations. Despite the fact that vertical deviations of greater than 2 D occurred in 5 patients with our crossed-adjustable transposition technique, only 2 of these patients needed subsequent surgical correction for As for potential vision-threatening complications, our study had 1 patient with mild anterior segment ischemia in the conventional transposition group.…”

“…Nonadjustable techniques of transposition surgery have resulted in induced vertical deviations in 5% to 30% of cases. [8][9][10][11][12][13] The purposes of this work are to describe our new crossed-adjustable transposition technique for sixth nerve palsy and to retrospectively determine whether the crossed-adjustable transposition technique, which usually does not have to be combined with weakening of the ipsilateral medial rectus muscle, yields an equivalent or better alignment result than our previous "conventional transposition" techniques, which generally did require such medial rectus muscle weakening.…”

Vertical Muscle Transposition with Augmentation for Treatment of Exotropia Caused by Iatrogenic Lost Medial Rectus Muscle

“…(Helveston et al, 1980;Struck, 2009) Several variations of vertical transposition procedures for limitation of abduction have been described (Bansal et al, 2006;Couser et al, 2012;Flanders et al, 2001) with few reports specifically regarding transposition for limitation of adduction. (Aoki et al, 2003;Cho et al, 2008;Park et al, 2015) The majority of cases with limited adduction are associated with vertical rectus muscle paresis due to third nerve affection, thus limiting the utility of vertical muscle transposition in these cases.…”