Posterior fixation suture augmentation of full-tendon vertical rectus muscle transposition for abducens palsy

Objective: To evaluate the effect of augmenting full-tendon vertical rectus transpositions with posterior fixation sutures in patients with complete o r near-complete lateral rectus palsy. Methods: Transposition of the vertical recti to the lateral rectus muscle w as performed in seven patients with unilateral lateral rectus palsy (the me an angle of preoperative horizontal deviation in primary gaze was 36.7 pris m diopters (Delta); range, 25-62 Delta. of esotropia), A posterior fixation suture of 5.0 Mersilene (Ethicon, Somerville, NJ) was placed in sclera (14 -16 mm posterior to the limbus) adjacent to the lateral rectus and incorpor ated 1/3 belly width of each transposed vertical rectus muscle. Results: The mean angle of postoperative horizontal deviation in primary ga ze was 7.1 Delta (range, 0-20 Delta). The mean change in primary-position h orizontal deviation postoperatively was 41.2 Delta (range, 37-72 Delta). Fo ur patients were able to fuse without prism in primary gaze: three patients were orthophoric and one patient had a consecutive intermittent exotropia. The remaining three patients required prism correction to neutralize the p ostoperative gaze deviation. All patients had improvement in abduction. Mil d limitation of adduction was noted in three patients (range, -0.5 to -2.0) . Conclusions: Augmenting full vertical rectus muscle transpositions with pos terior fixation sutures improves the abducting effect of surgery without si gnificant limitation of adduction.