Effect of level of augmentation sutures on vertical muscle transposition for sixth nerve palsy

Abstract

Background Full tendon transposition remains one of the commonly used procedures for the management of complete sixth nerve palsy. Although many variations in the technique were described, a dose–response nomogram remains evasive. This study aimed at evaluating the effect of the position of the Foster augmentation suture on the effect of transposition. Patients and methods This is a retrospective chart review for cases that underwent full tendon transposition with augmentation sutures (without medial rectus recession). The main outcome measures were improvement in esotropia and improvement in abduction. Results Twenty-four patients were included. Group 1 included 14 patients who underwent anteriorly placed augmentation sutures, while group 2 included 10 patients who underwent posteriorly placed sutures. Assessment at 6 months postoperatively showed a mean improvement of esotropia of 39.29±6.46 prism diopters in group 1 compared with 63.5±12.92 prism diopters in group 2 (P<0.001). Similarly, abduction in group 1 improved by 14.64±6.92° compared with 32.50±7.91° in group 2 (P<0.001). Conclusion Posteriorly placed Foster augmentation sutures resulted in larger improvement of esotropia and abduction limitation.

Keywords

• abducent palsy
• foster
• transposition