Management of vertical deviations after vertical rectus transposition surgery.

PURPOSE

To describe options for the management of vertical deviations after vertical rectus muscle transposition surgery (VRT).

METHODS

Retrospective case series including 7 children who underwent VRT for esotropic Duane syndrome and developed the complication of a vertical deviation.

RESULTS

Eighty-two consecutive children underwent VRT for Duane syndrome. Seven eyes of 7 patients (4 boys, 3 girls) were found to have induced vertical deviations postoperatively. Average length of follow-up was 12.7 months (range, 3-28 months). Median induced vertical deviation was 10.1(Delta) (range, 8-12). All patients required only one additional surgery to ameliorate the vertical deviation. At final follow-up, the mean vertical tropic deviation was 0. Six patients were operated on within 4 days of VRT. Surgical strategies included recession of one vertical rectus muscle and repositioning of a posterior fixation suture.

CONCLUSIONS

In children undergoing VRT for esotropic Duane syndrome, the complication of a vertical deviation occurred in 8.5% of cases. The vertical deviation was completely ameliorated in each case by one surgical procedure involving recession of one of the transposed muscles.