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.