This study reports the surgical outcomes of patients with vertical rectus palsy in whom the vertical duction deficit is worse in abduction than in adduction. The procedure involved lateral rectus belly transposition without muscle splitting or disinsertion. The lateral rectus belly was tied with non-absorbable 5-0 polyester suture and the belly then transposed downward and fixed to sclera temporal and posterior to the palsied inferior rectus; or upward transposition for superior rectus palsy. The study included 13 patients aged 36 ±16 years at time of surgery (seven male). Follow-up was 20.4 ±8 months. Superior rectus trauma was recorded for seven patients, monocular elevation deficit for two, orbital surgery for two, and retrobulbar anesthesia for two. Three had upward transposition and 10 had downward transposition. Mean preoperative vertical deviation was 31.4 ±16.4PD reducing postoperatively to 1.9 ±3.6PD. Mean vertical duction limitation was -2.7 ±0.6 units reducing to -0.6 ±0.5. Mean net fundus torsion was 11.6 ±8.2 degrees reducing to 3.9 ±2.4 degrees. Preoperative diplopia was noted in 11 patients which was eliminated for nine patients postoperatively. Success rate was 76.9%. The authors acknowledge limitations of this study as being retrospective, small sample size and absence of a control group. They recommend a future comparative study addressing long-term safety and effectiveness. They report advantages of a simple, safe, and reversible procedure which allows ipsilateral antagonist muscle recessions is also required.
Lateral rectus transposition for vertical rectus muscle palsy
Reviewed by Fiona Rowe
Outcomes of a simple lateral rectus belly transposition procedure combined with ipsilateral antagonist recession for vertical rectus palsy.
CONTRIBUTOR
Fiona Rowe (Prof)
Institute of Population Health, University of Liverpool, UK.
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