ADJUSTABLE VERTICAL RECTUS MUSCLE TRANSPOSITION SURGERY

Transposition of the vertical rectus muscle to the insertion of a para lytic or aberrantly innervated lateral rectus muscle is useful in trea ting esotropia associated with abducens palsy and Duane syndrome. Howe ver, this procedure may cause a manifest vertical deviation, requiring either prismatic or additional surgical correction. In an attempt to reduce the incidence of this surgical complication, we performed verti cal rectus muscle transposition surgery, using an adjustable suture te chnique on each muscle, in 10 consecutive patients with abnormal later al rectus function. Preoperative diagnoses included abducens palsy (70 %) and Duane syndrome (30%). Preoperative deviations ranged from 14 to 85 prism diopters esotropia (mean, 39 Delta) in the primary position. No vertical deviation was present preoperatively. Following transposi tion surgery, 8 of 10 patients were esotropic, 1 of 10 patients was ex otropic, and 4 of 10 patients had a manifest vertical deviation. At th e time of adjustment, all vertical deviations were corrected by ''rece ssing'' the appropriate vertical rectus muscle. Additionally, exotropi a was lessened by ''recessing'' both vertical muscles in one patient.