Vertical muscles transposition with medical rectus botulinum toxin injection for abducens nerve palsy

Abstract EN

Finding an alternative to ipsilateral medial rectus recession when performing superior and inferior rectus transposition surgery; thus eliminating the risk of anterior segment ischemia and overcorrection.

Fourteen patients with sixth nerve palsy of more than 8 month duration were included in the study.

Ages ranged between 6 to 76 years old.

All the patients underwent full tendon transposition of the Superior and Inferior rectus muscles to the lateral rectus muscle insertion and injection of the ipsilateral medial rectus muscle with botulinum toxin.

Two patients had significant esotropia (more than 8 prisms) and were advised to have a recession surgery for the ipsilateral medial rectus.

Six patients had a non-significant esotropia, 4 patients were ortho and 2 were exotropic (less than 12 prisms).

Transposition procedures are the best option for treating abducens nerve palsy and almost always require an ipsilateral medial rectus recession, thus rendering some patients at risk for developing anterior segment ischemia.

The results of this study are encouraging ; injecting the medial rectus muscle with botulinum toxin at the time of surgery can replace the need to recess the muscle and reduces the risk of anterior segment ischemia.

The author hopes this study will encourage others to consider this procedure.