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Dr. Kuldeep Srivastava, MS,

Electronic Poster No. FP756. Two stage surgical correction of Complete Sixth Nerve Palsy. Dr. Kuldeep Srivastava, MS,. Indira Gandhi Eye Hospital and Research Centre Lucknow. Sixth Nerve Palsy. Goals of surgical treatment Correcting esotropia in primary position Improving abduction

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Dr. Kuldeep Srivastava, MS,

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  1. Electronic Poster No. FP756 Two stage surgical correction of Complete Sixth Nerve Palsy Dr. Kuldeep Srivastava, MS, Indira Gandhi Eye Hospital and Research Centre Lucknow

  2. Sixth Nerve Palsy Goals of surgical treatment • Correcting esotropia in primary position • Improving abduction • Decreasing or eliminating face turn • Centering or expanding single binocular fields

  3. Sixth Nerve Palsy Surgical options • Recession-resection of horizontal rectus muscles • Transposition of vertical rectus muscles to lateral rectus muscle, with/without posterior fixation sutures • Usually requires Ipsilateral medial rectus recession • 3 muscle surgery – risk of Anterior Segment Ischemia

  4. Purpose of the study To evaluate the results of Two stage surgical correction of complete Sixth N palsy

  5. Patients and Methods • Retrospective study • Eight patients of complete sixth nerve palsy • Two stage surgical correction at 4-6 weeks interval • Complete ophthalmic & orthoptic examination • Esotropia in primary position were recorded • Voluntary abduction recorded on 6 point scale • Forced duction test & Forced generation test

  6. Patients and Methods Surgical technique • Limbal approach • Two stage surgical correction at 4-6 weeks interval • Stage I – Ipsilateral Medial Rectus Recession • Stage II – Transposition of vertical rectus muscles to lateral rectus muscle, augmented with posterior fixation sutures (Foster1997)

  7. Vertical rectus muscle transposition Transposition with Augmentation

  8. Results • Eight patients, aged 8 – 30 years • All were female • All had congenital Sixth Nerve palsy • No BSV • All had Ipsilateral Medial Rectus muscle recession • All had full tendon VRT with augmentation

  9. Results • Pre op deviation: 66.7 PD (30 – 90 PD) • Post op deviation: 6.8 PD (0 – 10 PD) • Pre op abduction: -4 or -5 • Post op abduction: -2 or -3 • No induced vertical deviation • No signs of anterior segment ischemia

  10. Pre operative Left LR palsy Post operative (after left medial rectus muscle recession) Post operative (after vertical rectus muscle transposition to lateral rectus

  11. Discussion • Recess-Resect - temporary effect in VI N palsy • Vertical Rectus Muscle Transposition - Hummelsheim procedure - Jensen procedure - Full tendon transposition (Schillinger ) • Usually requires Ipsilateral MR recession • 3 muscle surgery - Risk of Anterior Segment Ischemia

  12. Conclusion Two stage surgical correction is an effective procedure in correcting esotropia and improving abduction in VI N palsy, without increasing the risk of Anterior Segment Ischemia

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