Effect of unilateral vertical transposition of the horizontal rectus muscles on vertical strabismus

Abstract

Purpose:

To study the effect of vertically transposing both horizontal eye muscles of one eye in the same direction on vertical strabismus.

Methods:

Retrospective analysis of 33 patients in whom vertical transposition of the medial and lateral rectus muscles was combined with a recession/resection or recession/plication procedure. Preoperative ocular alignment was compared with that 1 day and 3 months postoperatively.

Results:

Mean preoperative vertical deviation was 7.8 ± 4.3 (median 7.5, range 3–25) prism diopters (PD) at distance and 7.8 ± 4.1 (7, 0–18) PD at near. Vertical transposition of the horizontal rectus muscles averaged 5.6 ± 1.6 mm and reduced the vertical deviation to 3.4 ± 4.2 PD (2, 0–16) at distance and 2.9 ± 3.7 PD (2, 0–14) at near. Mean effect on the vertical deviation was 0.9 ± 0.7 (0.8, –0.8 to 2.13) PD/mm at distance and 0.9 ± 0.9 (0.83, –1 to 3) PD/mm at near, it was similar in patients operated on for esotropia and for exotropia. The surgical effect on the horizontal deviation was 2.1 ± 1.1 PD/mm (distance) and 2.6 ± 1 PD/mm (near). Both the vertical and horizontal surgical dose correlated with the effect in a linear way, but the variability was greater for the vertical transposition.

Conclusions:

Vertical transposition of the horizontal rectus muscles in the same direction allows for correction of vertical strabismus. This procedure may be performed during primarily horizontal strabismus surgery, without operating on an additional extraocular muscle. The transposition distance correlates with the surgical effect but predictability of the effect is limited.

Keywords

Vertical strabismus hypertropia hypotropia vertical transposition of the horizontal extraocular muscles

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References

Alvaro

. Simultaneous surgical correction of vertical and horizontal deviations. Ophthalmologica 1950; 120(4): 191–197.

Foster

Pemberton

. The effect of operative alterations in the height of the external rectus insertion. Br J Ophthalmol 1946; 30: 88–92.

Foster

Pemberton

. Hypertropia corrected by changes of the lateral rectus insertion. Br J Ophthalmol 1954; 38(8): 507–509.

Jones

. Treatment of hypertropia by vertical displacement of horizontal recti. Am Orthopt J 1977; 27(1): 107–114.

O’Neill

. Surgical management of small-angle hypertropia by vertical displacement of the horizontal rectus muscles. Am Orthopt J 1978; 28: 32–42.

Metz

. Rectus muscle transposition surgery. J Pediatr Ophthalmol Strabismus 1981; 18(6): 51–54.

Struck

Hariharan

Kushner

, et al. Surgical management of clinically significant hypertropia associated with exotropia. J AAPOS 2010; 14(3): 216–220.

Willshaw

O’Connor

. Transposition surgery in childhood strabismus. Eye (Lond) 1988; 2(Pt 1): 41–43.

Heede

Salchow

. [Comparison of hang-back medial rectus recession with conventional recession for the correction of esotropia in children]. Klin Monbl Augenheilkd 2014; 231(10): 988–993.

10.

Schönfeld

Heede

Salchow

. [Comparison of hang-back recession and conventional recession for correction of exotropia]. Ophthalmologe 2016; 113(5): 402–408.

11.

Paque

Mumma

. Vertical offsets of the horizontal recti. J Pediatr Ophthalmol Strabismus 1978; 15(4): 205–209.

12.

Metz

. The use of vertical offsets with horizontal strabismus surgery. Ophthalmology 1988; 95(8): 1094–1097.