Augmented superior rectus muscle transposition in management of defective ocular abduction

Mohamed F Farid,Ahmed E M Daifalla,Mohamed A Awwad

doi:10.1186/s12886-020-01779-1

Mohamed F Farid, Ahmed E M Daifalla + Show 1 more

Open Access

https://doi.org/10.1186/s12886-020-01779-1

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Journal: BMC Ophthalmology	Publication Date: Jan 20, 2021
Citations: 5	License type: open-access

Affiliation: Benha University, King's College Hospital

Abstract

BackgroundSuperior rectus muscle transposition (SRT) is one of the proposed transposition techniques in the management of defective ocular abduction secondary to chronic sixth nerve palsy and esotropic Duane retraction syndrome (Eso-DRS). The aim of the current study is to report the outcomes of augmented SRT in treatment of Eso-DRS and chronic sixth nerve palsy.Methodsa retrospective review of medical records of patients with Eso-DRS and complete chronic sixth nerve palsy who were treated by augmented full tendon SRT combined with medial rectus recession (MRc) when intraoperative forced duction test yielded a significant contracture. Effect on primary position esotropia (ET), abnormal head posture (AHP), limitation of ocular ductions as well as complications were reported and analyzed.Resultsa total of 21 patients were identified: 10 patients with 6th nerve palsy and 11 patients with Eso-DRS. In both groups, SRT was combined with ipsilateral MRc in 18 cases. ET, AHP and limited abduction were improved by means of 33.8PD, 26.5°, and 2.6 units in 6th nerve palsy group and by 31.1PD, 28.6°, and 2 units in Eso-DRS group respectively. Surgical success which was defined as within 10 PD of horizontal orthotropia and within 4 PD of vertical orthotropia was achieved in 15 cases (71.4%). Significant induced hypertropia of more than 4 PD was reported in 3 patients (30%) and in 2 patients (18%) in both groups, respectively.Conclusionaugmented SRT with or without MRc is an effective tool for management of ET, AHP and limited abduction secondary to sixth nerve palsy and Eso-DRS. However, this form of augmented superior rectus muscle transposition could result in high rates of induced vertical deviation.

Highlights

Superior rectus muscle transposition (SRT) is one of the proposed transposition techniques in the management of defective ocular abduction secondary to chronic sixth nerve palsy and esotropic Duane retraction syndrome (Eso-DRS)
The aim of this study is to evaluate the results of dually augmented SRT with or without medial rectus recession (MRc) for correction of ET, abnormal head posture (AHP) and limited abduction associated with Eso-DRS and sixth nerve palsy
The review of medical records revealed a total of 21 patients, patients with chronic sixth nerve palsy and patients with Eso-DRS, who were treated by augmented SRT

Summary

Introduction

Superior rectus muscle transposition (SRT) is one of the proposed transposition techniques in the management of defective ocular abduction secondary to chronic sixth nerve palsy and esotropic Duane retraction syndrome (Eso-DRS). Lateral transposition of vertical recti (VRT), either full or partial tendon, is a well-established surgical strategy to overcome esotropia (ET) and defective ocular abduction associated with esotropic Duane retraction syndrome (Eso-DRS) and sixth nerve palsy [1, 2]. In many instances, this transposition is combined with recession of ipsilateral medial rectus muscle (MRc) to control larger deviations especially in cases with MR contracture [3]. The aim of this study is to evaluate the results of dually augmented SRT with or without MRc for correction of ET, abnormal head posture (AHP) and limited abduction associated with Eso-DRS and sixth nerve palsy

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