Modified transposition procedure of the vertical recti in sixth nerve palsy

PURPOSE: To report a modified transposition procedure of the vertical recti for severely limited abduction of the globe caused by sixth nerve palsy an d to compare this with the Hummelsheim transposition procedure. METHODS: Retrospective study of 13 eyes of 12 patients that had Hummelsheim transposition procedure and 19 eyes of 17 patients that had modified trans position procedure of the vertical recti for severely limited abduction of the globe caused by sixth nerve palsy. The modified transposition procedure joins lateral strips of the vertical recti and sutures this junction to th e lateral rectus muscle, Functional results of the Hummelsheim procedure ar e compared with functional results of the modified transposition procedure. RESULTS: Abductive capacity improved by 4.19 +/- 1.67 mm in the Hummelsheim group and 4.08 +/- 1.7 mm in the modification. The angle of squint changed from +22.33 +/- 6.74 degrees to -0.20 +/- 2.61 degrees in the Hummelsheim group and from +25.54 +/- 5.66 degrees to +0.95 +/- 5.26 degrees in the mod ification group. The functional results as to abductive capacity and postop erative angle of squint showed no significant difference between the two me thods (P > .05, t test). The modification was less time consuming. CONCLUSIONS: A modification of the transposition techniques of eye muscles in sixth nerve palsy is introduced. Its functional results are comparable t o the classic technique of Hummelsheim, Operative risk and trauma are reduc ed, because the technique avoids scleral stitches and was found to be less time consuming than the Hummelsheim procedure. (Am J Ophthalmol 2001;131:35 9-363. (C) 2001 by Elsevier Science Inc. All rights reserved.).