The Effect of Augmentation with a Posterior Fixation Suture in Superior Rectus Transposition for Abducens Nerve Palsy

Abstract

Objective: To investigate the effect and complications of augmentation with a posterior fixation suture in superior rectus transposition (SRT) for abducens nerve palsy. Methods: Two groups of patients with abducens nerve palsy treated with either SRT combined with a posterior fixation suture (A-SRT group, n=10) or SRT (SRT group, n=11) were analyzed retrospectively from March 2014 to January 2019 in Xuzhou No.1 People's Hospital. Changes in esotropia, vertical deviation, cyclotropia, and improvements in abduction and adduction limitation were compared between the two groups. The follow-up time was 10-12 months. The data were analyzed by a Wilcoxon rank sum test and Mann-Whitney test. Results: There were significant differences between the A-SRT and SRT groups in esotropia (Z=-2.940, P<0.001) and abduction limitation (Z=-3.272, P=0.001). The variations in esotropia were 40.0° (36.0°-45.0°) in the A-SRT group and 28.0° (25.0°-30.0°) in the SRT group and the variations in abduction limitation were 2.0 (1.0-2.0) and 1.0 (1.0-1.0), respectively. There was no significant difference between the two groups in adduction limitation (Z=-1.855, P=0.064) or vertical deviation (Z=-1.505, P=0.132). There was a significant difference between the two groups in the variation of subjective in cyclotropia inspected by adouble Maddox rod (Z=-2.228, P=0.026). There was an incyclotorsional shift of 3.0° (0.0°-4.25°) in the A-SRT group and 0.0° (0.0°-2.0°) in the SRT group. But there were no complaints of rotational or vertical discomfort in either group. Conclusion: In augmentation with a posterior fixation suture in SRT for abducens nerve palsy, although there is a possibility of slight in cyclotropia or adduction limitation, abduction limitation was optimally corrected and the correction of esotropic deviation in the primary position was perfect without any obvious subjective complaints of vertical or torsional diplopia. Key words: posterior fixation suture; superior rectus transposition; abducent nerve palsy; cyclotropia; vertical deviation