Single Horizontal Muscle (Medial or Lateral Rectus) Transposition and Inferior Rectus Recession in Monocular Elevation Deficit: A Novel Surgical Technique.

Abstract

To describe a novel surgical technique for the treatment of monocular elevation deficit and report its short-term outcomes. This was a prospective interventional case series. It was an institutional-based study of 5 patients with monocular elevation deficit. A single horizontal rectus muscle was transposed to 2 mm from the insertion of the superior rectus muscle along the spiral of Tillaux, augmenting it with a non-absorbable suture taken 8 mm behind its insertion. The main outcome measures were primary position hypotropia and elevation deficit at 8 months postoperatively. The mean age was 12.4 years (range: 6 to 26 years). Four patients underwent lateral rectus transposition and one underwent medial rectus transposition. Inferior rectus recession was done in all patients. The mean follow-up period was 8 months (range: 6 to 12 months). The mean hypotropia reduced from 34.6 prism diopters (PD) (range: 20 to 48 PD) preoperatively to 0.8 PD (range: -4 to 8 PD) at 8 months postoperatively. Additionally, 3 patients had exotropia with a mean of 12 PD (range: 2 to 20 PD) and 2 had esotropia with a mean of 28.5 PD (range: 12 to 40 PD); 1 underwent lateral rectus recession and 1 medial rectus recession. Three patients did not require any horizontal muscle surgery. The mean elevation deficit in abduction, straight up gaze, and adduction improved from 4.4, 3.2, and 2.8 to 2.0, 2.0, and 1.8, respectively. The mean depression deficit was 0.5. No adverse effects were noted. Single horizontal muscle transposition with inferior rectus recession allows sparing of at least one horizontal muscle and achieves adequate elevation effect and primary position deviation correction, at least in the short-term follow-up. [J Pediatr Ophthalmol Strabismus. 2019;56(3):183-187.].