Full-tendon transposition surgery effective for palsies, Duane’s syndrome

WASHINGTON — Full-tendon rectus muscle transposition surgery is an effective treatment for patients with complete loss of function in the rectus muscle due to a nerve palsy, said Arthur L. Rosenbaum, MD.

Dr. Rosenbaum presented these remarks in his Costenbader Lecture here at the American Association of Pediatric Ophthalmology and Strabismus annual meeting.

“Rectus muscle transposition effectively increases the size of the binocular diplopia-free field in patients with complete third- or sixth-nerve palsy or Duane’s syndrome,” Dr. Rosenbaum said. When effective, the procedure improves the rotation in the field of action of a paralyzed muscle and expands the patient’s area of nondiplopic vision.

Full-tendon rectus transposition surgery has been a controversial procedure for complete nerve palsies of the eye, with skeptics favoring partial tendon transposition. While questions remain as to the accuracy of abduction following surgery, Dr. Rosenbaum said that the procedure is the most effective treatment today for complete nerve palsies.

In a study of 64 augmented and nonaugmented cases of patients with muscle palsy or Duane’s Syndrome, full-tendon rectus muscle transposition surgery corrected esotropia in 25% to 30% of patients. The majority of patients experienced 70 degrees of visual field improvement.

Dr. Rosenbaum looks to future procedures to offer greater patient benefit.

“The reanimation of an intact palsied muscle by external stimulation is an exciting option for the future,” he said.