Outcomes Following Superior Rectus Transposition and Medial Rectus Recession vs. Inferior and Superior Recti Transposition for Acquired Sixth Nerve Palsy
Scott R. Lambert; Yeon-Hee Lee
Introduction: To compare effectiveness of superior rectus transposition/medial rectus recession (SRT/MR) vs. inferior and superior rectus transposition (VRT) for acquired sixth nerve palsy.
Methods: The medical records of a case-control series of patients with acquired sixth nerve palsy who underwent VRT (1988-2005) or SRT/MR (2013-16) by a single surgeon were reviewed. The pre and postoperative findings were compared between the two groups.
Results: Eight patients underwent SRT/MR and VRT. Lateral fixation was performed on all but 4 patients in VRT group. Median follow-up was 6 months in SRT/MR group and 17 months in VRT group. Preoperative esotropia in primary position and abduction deficit were similar in both groups (SRT/MR, 42 PD, -4.6; VRT, 56 PD, -4.5; p=0.195, p=1.0). SRT/MR group underwent a mean MR recession of 6.0 mm (range, 5-7). Four patients in VRT group underwent MR recession (mean 5.3 mm). In addition, 5 patients in the VRT group had 9 injection of BOTOX in the MR. No additional procedures were performed in SRT/MR group. Fewer additional procedures were performed with SRT/MR (SRT/MR, 0; VRT, 1.8±1.2; p<0.010). At last follow-up, residual esotropia (SRT/MR, 7 PD; VRT, 10 PD; p=0.442) was similar in both groups. But the abduction was better in the SRT/MRc group (SRT/MR, -3.0±0.7; VRT, -3.8±0.4; p=0.038). There were no new persistent vertical deviations or torsional diplopia.
Discussion: Both SRT/MR and VRT procedures improved ocular alignment in primary position and abduction without creating persistent vertical deviations.
Conclusion: Final outcomes were similar with SRT/MR vs. VRT. However, fewer additional surgical procedures were needed with SRT/MR.
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