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The purpose of this study was to evaluate both the amount of correction obtained and the postoperative drift that occurred with two frequently used vertical rectus muscle transposition (VRT) procedures to determine the ideal immediate postoperative alignment. Twenty-seven patients underwent VRT for total sixth nerve palsy. Group a consisted of 16 patients undergoing full tendon transposition with Foster augmentation by posterior fixation suture to the sclera (FTT-FA). Group b consisted of 11 patients undergoing partial tendon transposition with 4mm resection of the transposed segment of the vertical rectus muscle with medial rectus recession (PTT-R-MR). Mean preoperative angle was 53PD (35-90PD) in group a and 55PD (35-95PD) in group b reducing to 17PD esotropia (12exo to 75eso) and 55PD (35-95 eso) respectively. By two months follow-up group a had a mean angle of 17PD eso (12 exo to 75 eso) with mean total eso drift of 6 ±9PD and total correction of 40 ±13PD. Group b had a mean angle of 4 eso (15 exo to 20 eso) with mean total eso drift of 16 ±11PD and mean total correction of 52 ±19PD. A non-significant trend was towards greater correction in group b. Difference in the amount of drift was significant and greater in group b with surgical success defined as <10PD. Success rate was 73% for group b and 44% for group a. Limitations of the study included its retrospective design, small sample size and different numbers in each group, different examiners and surgeons. However, the authors conclude their study provides valuable information through comparing two VRT procedures. 

Postoperative correction and drift after vertical rectus muscle transposition for total sixth cranial nerve palsy.
Rothfield L, Cavuoto KM, Reyes-Capo DP, et al.
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Fiona Rowe (Prof)

Institute of Population Health, University of Liverpool, UK.

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