Abstract
Purpose
To report a series of cases, who developed consecutive exodeviation after vertical muscle transposition (VRT) performed for sixth nerve palsy, describe their management and analyse their outcome.
Design
Retrospective case series.
Methods
This is an institutional study on patients who developed consecutive exotropia following VRT for sixth nerve palsy in two different centres. The age, gender, cause, and time to surgery were reviewed. Ductions, versions and angles of misalignment were analysed. In those who developed an exotropia >10 PD after surgery, a second surgery was performed. The time to the second surgery, intra-operative findings, surgical procedure and outcome were studied.
Results
A total of 164 cases of VRT for sixth nerve palsy were identified. Nine patients developed consecutive exotropia >10 PD (5.5%). There were no significant differences in the characteristics of those who developed overcorrection compared to those who did not. Five patients had full-tendon muscle transposition, three patients had Hummelsheim procedure and one patient had Jensen procedure. The average angle of consecutive exotropia was 26 ± 9 Δ (range 10–40 Δ). After the second surgery, angle of exotropia decreased to 21 ± 15 PD. Seven patients still had residual exotropia ≥10Δ and the exotropia was corrected in the remaining two patients. The time to second surgery in those two patients was much shorter than the other seven patients.
Conclusions
Patients who undergo VRT should be followed up in the early post-operative period and revisiting the transposition should be done immediately in case of consecutive exotropia to avoid permanent overcorrection.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Nelson L. B. Strabismus disorders. In: Nelson L. B., Calhoun J. H., Harley R. D., editors. Pediatric Ophthalmology. 3rd ed. Philadelphia: WB Saunders; 1991. p. 149–68.
Rush JA, Younge BR. Paralysis of cranial nerves III, IV, and VI: cause and prognosis in 1000 cases. Arch Ophthalmol. 1981;99:76–9.
Gunton KB. Vertical rectus transpositions in sixth nerve palsies. Curr Opin Ophthalmol. 2015;26:366–70.
O’Connor RJ. Tendon transplantation in ocular muscle paralysis. Am J Ophthalmol. 1935;18:813–20.
Hummelsheim E. Weitere Ertahrungen mit partieller Sehnenüberpflanzung an den Augenmuskein. Arch Augenheilkd 2021;62:71–4.
Foster RS. Vertical muscle transposition augmented with lateral fixation. J Am Assoc Pediatr Ophthalmol Strabismus. 1997;1:20–30.
Jensen CD. Rectus muscle union: a new operation for paralysis of the rectus muscles. Trans Pac Coast Otoophthalmol Soc. 1964;45:359–87.
Scott AB. Botulinum injection of eye muscle to correct strabismus. Trans Am Ophthalmol Soc. 1981;79:734–70.
Scott AB, Kraft SP. Botulinum toxin injection in the management of lateral rectus paresis. Ophthalmology. 1985;92:676–83.
Lee JY, Lim HW, Yoon J, Oh JE, Park KA, Oh SY. Comparison of the Efficiency of Various Muscle Transposition Procedures Using a Novel Three-Dimensional Model. PLoS ONE. 2018;13:e0204078.
Nihalani BR, Hunter DG. Adjustable suture strabismus surgery. Eye. 2011;25:1262–76.
Zhang MS, Hutchinson AK, Drack AV, Cleveland J, Lambert SR. Improved ocular alignment with adjustable sutures in adults undergoing strabismus surgery. Ophthalmology. 2012;119:396–402.
Engel JM. Adjustable sutures: an update. Curr Opin Ophthalmol. 2012;23:373–6.
Haridas A, Sundaram V. Adjustable versus non-adjustable sutures for strabismus. Cochrane Database Syst Rev. 2005;1:CD004240 https://doi.org/10.1002/14651858.CD004240.pub2
Paysse EA, Brady MKM, Ross A, Coats DK. Use of augmented rectus muscle transposition surgery for complex strabismus. Ophthalmology. 2002;109:1309–14.
Simons BD, Siatkowski RM, Neff AG. Posterior fixation suture augmentation of full-tendon vertical rectus muscle transposition for abducens palsy. J Neuroophthalmol. 2000;20:119–22.
Leiba H, Wirth GM, Amstutz C, Landau K. Long-term results of vertical rectus muscle transposition and botulinum toxin for sixth nerve palsy. J AAPOS. 2010;14:498–501.
Couser NL, Lenhart PD, Hutchinson AK. Augmented Hummelsheim procedure to treat complete abducens nerve palsy. J AAPOS. 2012;16:331–5.
Rosenbaum AL, Santiago AP. Clinical strabismus management: principles and surgical techniques. David Hunter; 1999.
Author information
Authors and Affiliations
Contributions
Design and conduct of the study: AE, AA, HE, DH. Collection, management of data: AE, AA, HE, Analysis and interpretation: AE, AA, DH. Preparation, review or approval of the paper: AE, AA, HE, DH.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary information
Rights and permissions
About this article
Cite this article
Elkamshoushy, A., Awadein, A., Elhilali, H. et al. Overcorrection after vertical muscle transposition with augmentation sutures in sixth nerve palsy. Eye 37, 127–131 (2023). https://doi.org/10.1038/s41433-021-01660-5
Received:
Revised:
Accepted:
Published:
Version of record:
Issue date:
DOI: https://doi.org/10.1038/s41433-021-01660-5
