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

Wadakarn Wuthisiri; Supawan Surukratanaskul; Apatsa Lekskul

doi:10.14456/rmj.2018.36

Authors

Wadakarn Wuthisiri Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Supawan Surukratanaskul Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Apatsa Lekskul Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

DOI:

https://doi.org/10.14456/rmj.2018.36

Keywords:

Vertical rectus muscle transposition, Cranial sixth nerves palsy, Esotropia

Abstract

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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