No-Split, No-Tenotomy Transposition of Only the Superior Rectus Muscle Combined With Medial Rectus Recession in Patients With Complete Abducens Nerve Palsy Publisher Pubmed



Akbari MR¹ ; Reza T¹ ; Sadeghi M¹ ; Masoomian B¹ ; Mirmohammadsadeghi A¹
Source: Journal of AAPOS Published:2023

Abstract

Purpose: To evaluate the outcomes of no-split, no-tenotomy transposition of only the superior rectus muscle combined with medial rectus recession in patients with complete abducens nerve palsy. Methods: In this procedure, the temporal margin of the superior rectus muscle, 10 mm posterior to the insertion, was secured with a nonabsorbable suture and sutured to the sclera at a distance of 12 mm from the limbus in the superotemporal quadrant, halfway between the superior rectus and lateral rectus. Success was defined as distance and near alignment of ≤8Δ and no diplopia in primary position 6 months after surgery. Results: A total of 8 patients with abducens nerve palsy underwent the procedure. At the last follow-up, the mean postoperative change in primary position deviation was 42.6Δ ± 8.1Δ (range, 34Δ-57Δ) for distance and 42.1Δ ± 7.5Δ (35Δ -57Δ) for near, a significant reduction (P = 0.012). Abduction deficit also improved significantly (P = 0.010). Postoperatively, no vertical deviation or torsional diplopia was induced. At the 6 months’ follow-up, compared with the first postoperative visit, an esodrift at near developed in 1 patient. Of the 8 cases, 6 fulfilled the criteria for success. Conclusions: In our small study cohort, no-split, no-tenotomy superior rectus transposition and medial rectus recession improved esotropia and abduction limitation without inducing significant vertical deviations or torsional diplopia. © 2023 American Association for Pediatric Ophthalmology and Strabismus