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 or near-complete lateral rectus palsy. Methods: Transposition of the vertical recti to the lateral rectus muscle was performed in seven patients with unilateral lateral rectus palsy (the mean angle of preoperative horizontal deviation in primary gaze was 36.7 prism diopters (Δ); range, 25-62Δ 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 incorporated 1/3 belly width of each transposed vertical rectus muscle. Results: The mean angle of postoperative horizontal deviation in primary gaze was 7.1Δ (range, 0-20Δ). The mean change in primary-position horizontal deviation postoperatively was 41.2Δ (range, 37-72Δ). Four 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 postoperative gaze deviation. All patients had improvement in abduction. Mild limitation of adduction was noted in three patients (range, −0.5 to −2.0). Conclusions: Augmenting full vertical rectus muscle transpositions with posterior fixation sutures improves the abducting effect of surgery without significant limitation of adduction.