Vertical muscle transposition augmented with lateral fixation (Foster) suture for Duane syndrome and sixth nerve palsy

Abstract

Purpose To report the postoperative results of full-tendon vertical rectus transposition (VRT) augmented with lateral fixation suture for the treatment of type 1 Duane syndrome and sixth nerve palsy and to determine whether there was a decrease in the effect of the Foster suture over time. Methods This retrospective, consecutive case series included patients who underwent a full-tendon VRT transposition with lateral fixation for type 1 Duane syndrome or sixth nerve palsy. The primary outcome measures included deviation, abnormal head posture (AHP), abduction deficiency, and postoperative binocular single visual field (BSVF). Results Eighty-seven patients (87 eyes: 40 eyes with Duane syndrome and 47 eyes with sixth nerve palsy) were included in this study. In Duane syndrome patients, the deviation was reduced by a mean of 95%, the AHP was eliminated in 86% of patients, the abduction was improved by 42%, and a useful BSVF of B67% of normal was achieved at 1 year post operation. In sixth nerve palsy patients, the deviation was reduced by 99%, the abduction was improved by 59%, and a useful BSVF of B71% of normal was achieved at 1 year post operation. In both groups, the improvements in deviation angle and abduction were stable postoperatively. Sixteen patients needed reoperation for undercorrection. Conclusion VRT surgery with posterior fixation is an effective treatment method for complete sixth nerve palsy and Duane syndrome with esotropia, AHP, and abduction deficiency. The procedure carries a small risk of reoperation for undercorrection. The effect of the Foster suture did not decline over time.

The clinical features and management of Duane’s retraction syndrome type 2 in pediatric patients

“…In the literature, much has been written about the most common DRS form (type 1) (7,10,11). However there are only few studies about type 2 DRS, and this is the first study to discuss the clinical features and management of pediatric DRS type 2 patients.…”

“…Ocular deviation in the primary position of gaze was measured using a cover test with the uninvolved eye fixed on a target. Abnormal head posture (AHP) was estimated for all patients while the patient sat erect, fixating on a target 20 feet distant as previously described (7)(8)(9).…”

Komplette vertikale Transposition der Vertikalmotoren modifiziert nach Foster als Operationstechnik für Abduzensparese

“…Diese Modifikation verbesserte deutlich die primäre Position und Abduktion ohne eine zusätzliche Rücklagerung des ipsilateralen M. rectus medialis, was die Durchblutung des Vorderabschnitts schont und das Risiko einer Vorderabschnittsischämie minimalisiert. Yazdian [12], Akar [13], del Pilar Gonzáles [3] Methods and Results Full tendon transpositions of vertical rectus muscles augmented with posterior fixation suture was performed in 2014 on five patients with abducens nerve palsy. Two of the patients received Botox injections in the medial rectus muscle: one of them three months after the surgery and another during the surgery.…”

Vertical rectus transposition in Duane’s syndrome: does co-contraction worsen?

“…We read with interest the article by Akar et al 1 We would like to make the following observations/queries.…”

“…It has been suggested that vertical rectus transposition (VRT) may worsen retraction and shoots. 2,3 Thus an objective measurement (pre-and postoperative) of palpebral aperture changes and shoots is in order, more so with augmented transposition as in Akar et al 1 Also, the confirmation of absence of anomalous LR innervation pre-operatively is essential. This may be assessed by the Romero-Apis force degeneration test 4 or, as suggested by some, by electromyography.…”