Original article
Modified transposition procedure of the vertical recti in sixth nerve palsy

https://doi.org/10.1016/S0002-9394(00)00805-9Get rights and content

Abstract

PURPOSE: To report a modified transposition procedure of the vertical recti for severely limited abduction of the globe caused by sixth nerve palsy and to compare this with the Hummelsheim transposition procedure.

METHODS: Retrospective study of 13 eyes of 12 patients that had Hummelsheim transposition procedure and 19 eyes of 17 patients that had modified transposition procedure of the vertical recti for severely limited abduction of the globe caused by sixth nerve palsy. The modified transposition procedure joins lateral strips of the vertical recti and sutures this junction to the lateral rectus muscle. Functional results of the Hummelsheim procedure are compared with functional results of the modified transposition procedure.

RESULTS: Abductive capacity improved by 4.19 ± 1.67 mm in the Hummelsheim group and 4.08 ± 1.7 mm in the modification. The angle of squint changed from +22.33 ± 6.74 degrees to −0.20 ± 2.61 degrees in the Hummelsheim group and from +25.54 ± 5.66 degrees to +0.95 ± 5.26 degrees in the modification group. The functional results as to abductive capacity and postoperative angle of squint showed no significant difference between the two methods (P > .05, t test). The modification was less time consuming.

CONCLUSIONS: A modification of the transposition techniques of eye muscles in sixth nerve palsy is introduced. Its functional results are comparable to the classic technique of Hummelsheim. Operative risk and trauma are reduced, because the technique avoids scleral stitches and was found to be less time consuming than the Hummelsheim procedure.

Section snippets

Methods

Since 1994, we have performed a modified transposition procedure of parts of the vertical recti in cases of severe abduction deficits in sixth nerve palsy. In order to analyze the efficacy of this surgical procedure, we compared perioperative parameters and postoperative results of this modified transposition procedure performed between 1994 and 1999 with the operation results from 1989 to 1994, which were conducted as classic transpositions of the Hummelsheim type. The records of 78 patients

Results

Both in the group of patients who underwent transposition of the classical Hummelsheim type (group 1) and in the group who received modified transposition (group 2), the cause of the sixth nerve palsies was related to trauma in the majority of cases, to vascular malformations or hemorrhages in the second greatest number of cases, and to tumors in the smallest number of cases. In both groups there was a slight overrepresentation of men (group 1, seven men and five women; group 2, nine men and

Discussion

The aim of the study was to compare the efficacy and handling of a modified transposition procedure in severely limited abduction with the classic Hummelsheim procedure. There is no gross disadvantage in the modified technique. On the contrary, there seems to be a slight advantage in the modification.

As to functional results, that is, improvement of abductive capacity and reduction of convergent squint, the modification was as effective as the classic procedure. The fact that there was no

References (13)

There are more references available in the full text version of this article.

Cited by (0)

View full text