Results of surgical management of abducens paralysis

Abstract

The pre- and postsurgical results after mono- and bilateral transposition surgery for abducens nerve palsy are reported. In 13 eyes from 11 patients with 6th nerve paralysis, transposition surgery modified after Kaufmann was performed after a median duration of 13 months (range 6-28 months). The actual angle of strabismus, the capability of abduction and the field of binocular single vision with the tangent screen according to Harms were measured prior to surgery, immediately after surgery (1-3 weeks) and in the later postsurgical period (9-12 months). Of the patients 7 achieved fusion with binocular single vision, 5 of these patients had to accept an ocular torticollis of 10 degrees (range 5-15 degrees) and 4 patients had a tendency to exclusion. Of the 11 patients, 9 were treated successfully with one single surgical procedure 2 of which had bilateral abducens nerve palsy and 2 patients needed 2 further operations. The median preoperative convergent angle in the primary position was reduced from 28 degrees (range 16 degrees-60 degrees) to a median angle of 0 degree, sometimes only latent (range D 7 degrees-C 4 degrees) in the late postoperative period. The median postoperative abduction over the midline was 10 degrees (range 3 degrees-25 degrees). Bilateral 6th nerve paralysis was treated effectively with simultaneous transposition surgery in both eyes. In most cases an additional weakening of the medial rectus muscle was not necessary. An initial overcorrection with exotropia in the early postoperative period is desired and is a predictive factor for a good late postoperative result.