The Surgical Outcome of Partial Vertical Rectus Muscle Transpositions (Jensen Procedure) Combined With Ipsilateral Medial Rectus Recession in Complete Sixth Nerve Palsy at Ramathibodi Hospital

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Wadakarn Wuthisiri
Supawan Surukratanaskul
Apatsa Lekskul


Background: There are many surgical approaches to treat sixth nerve palsy depend on residual lateral rectus function, which the vertical rectus muscle transpositions (VRT) procedure is the surgical of choice in complete sixth palsy. VRT procedures, including full-tendon and partial tendon transpositions, often are combined with medial rectus muscle weakening. Partial tendon VRT procedure aimed to create success rate similar to full-tendon transposition with reduced risk of anterior segment ischemia when combined with simultaneous ipsilateral medial rectus muscle recession.

Objective: To study the surgical outcomes of partial tendon transposition in sixth nerve palsies patients at Ramathibodi Hospital in the past 12 years.

Methods: Retrospective reviewed data from patients with complete sixth nerve palsy who underwent surgical treatment with the Jensen procedure from January 2006 to December 2017. Preoperative and postoperative data records were collected. Successful outcomes were residual horizontal deviation < 10 prism diopters at 6 months postoperatively. Paired t test was used, where P value < 0.05 was considered statistically significant.

Results: Nineteen patients underwent the modified Jensen procedure combined with ipsilateral medial rectus recession range 6 - 8 mm. Success rate was 73.68%. The mean esodeviation at distance improved from 54.26 ± 31.64 PD to 4.47 ± 12.89 PD (P < 0.01). The improvement of mean abduction deficit was -3.78 ± 0.41 to -2.21 ± 0.53 (P < 0.01).

Conclusions: The Jensen procedure combined with ipsilateral medial rectus recession could improve large angle of deviation in complete sixth nerve palsy with less complications.



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Wuthisiri, W., Surukratanaskul, S., & Lekskul, A. (2018). The Surgical Outcome of Partial Vertical Rectus Muscle Transpositions (Jensen Procedure) Combined With Ipsilateral Medial Rectus Recession in Complete Sixth Nerve Palsy at Ramathibodi Hospital. Ramathibodi Medical Journal, 41(3), 42–49.
Original Articles


Holmes JM, Beck RW, Kip KE, Droste PJ, Leske DA, Pediatric Eye Disease Investigator Group. Predictors of nonrecovery in acute traumatic sixth nerve palsy and paresis. Ophthalmology. 2001;108(8):1457-1460. doi:10.1016/S0161-6420(01)00633-9.

Wright KW. Color Atlas of Strabismus Surgery: Strategies and Techniques. 3rd ed. New York, NY: Springer; 2007:83-84.

Rosenbaum AL. Costenbader Lecture. The efficacy of rectus muscle transposition surgery in esotropic Duane syndrome and VI nerve palsy. J AAPOS. 2004;8(5):409-419. doi:10.1016/S1091853104001600.

Gunton KB. Vertical rectus transpositions in sixth nerve palsies. Curr Opin Ophthalmol. 2015;26(5):366-370. doi:10.1097/ICU.0000000000000178.

Hummelshein E. Uber Schnentransplantation am Ague. Ophthal Gesselschft. 1907;34:248-253.

Jensen CD. Rectus muscle union: a new operation for paralysis of the rectus muscles. Trans Pac Coast Otoophthalmol Soc Annu Meet. 1964;45:359-387.

Selezinka W, Sandall GS, Henderson JW. Rectus muscle union in sixth nerve paralysis. Jensen rectus muscle union. Arch Ophthalmol. 1974;92(5):382-386. doi:10.1001/archopht.1974.01010010394004.

Cline RA, Scott WE. Long-term follow-up of Jensen procedures. J Pediatr Ophthalmol Strabismus. 1988;25(6):264-269. doi:10.3928/0191-3913-19881101-04.

von Noorden GK. Anterior segment ischemia following the Jensen procedure. Arch Ophthalmol. 1976;94(5):845-847. doi:10.1001/archopht.1976.03910030419014.

Bleik JH, Cherfan GM. Anterior segment ischemia after the Jensen procedure in a 10-year-old patient. Am J Ophthalmol. 1995;119(4):524-525. doi:10.1016/S0002-9394(14)71248-6.

Vivian AJ, Morris RJ. Diagrammatic representation of strabismus. Eye (Lond). 1993;7(Pt 4):565-571. doi:10.1038/eye.1993.123.

Surachatkumtonekul T, Soontrapa P, Kampanartsanyakorn S, Dulayajinda D. Causes and treatment outcomes of third, fourth and sixth cranial nerve palsy. J Med Assoc Thai. 2012;95(Suppl 4):S96-101.

Couser NL, Lenhart PD, Hutchinson AK. Augmented Hummelsheim procedure to treat complete abducens nerve palsy. J AAPOS. 2012;16(4):331-335. doi:10.1016/j.jaapos.2012.02.015.

Foster RS. Vertical muscle transposition augmented with lateral fixation. J AAPOS. 1997;1(1):20-30. doi:10.1016/S1091-8531(97)90019-7.

Lee YH, Lambert SR. Outcomes after superior rectus transposition and medial rectus recession versus vertical recti transposition for sixth nerve palsy. Am J Ophthalmol. 2017;177:100-105. doi:10.1016/j.ajo.2017.02.019.

Leiba H, Wirth GM, Amstutz C, Landau K. Long-term results of vertical rectus muscle transposition and botulinum toxin for sixth nerve palsy. J AAPOS. 2010;14(6):498-501. doi:10.1016/j.jaapos.2010.09.012.

Mehendale RA, Dagi LR, Wu C, Ledoux D, Johnston S, Hunter DG. Superior rectus transposition and medial rectus recession for Duane syndrome and sixth nerve palsy. Arch Ophthalmol. 2012;130(2):195-201. doi:10.1001/archophthalmol.2011.384.

Phamonvaechavan P, Anwar D, Guyton DL. Adjustable suture technique for enhanced transposition surgery for extraocular muscles. J AAPOS. 2010;14(5):399-405. doi:10.1016/j.jaapos.2010.08.004.

Britt MT, Velez FG, Thacker N, Alcorn D, Foster RS, Rosenbaum AL. Partial rectus muscle-augmented transpositions in abduction deficiency. J AAPOS. 2003;7(5):325-332. doi:10.1016/S1091853103001800.

Patil-Chhablani P, Kothamasu K, Kekunnaya R, Sachdeva V, Warkad V. Augmented superior rectus transposition with medial rectus recession in patients with abducens nerve palsy. J AAPOS. 2016;20(6):496-500. doi:10.1016/j.jaapos.2016.07.227.