Full tendon transposition augmented with posterior intermuscular suture and recession--resection surgery

Abstract

Purpose: To report an effect of the full tendon transposition augmented with posterior intermuscular suture and recession-resection surgery, for the patient with monocular elevation deficiency (MED) and large exotropia.

Methods: Interventional case report. Full tendon transposition augmented with posterior intermuscular suture and recession-resection surgery was performed for a 26-year-old male patient had monocular elevation deficiency (MED) and large exotropia.

Results: Preoperative angle of deviation was 56 prism diopters (PD) hypotropia and 45 PD right exotropia, compared with 18 PD left hypertropia and 10 PD right esotropia postoperatively. Essotropia persisted after 2.5 years, however, and so the right medial rectus was recessed after removal of the previous posterior intermuscular suture. At a three-year follow-up after the second surgery, alignment was straight in the primary position at near and far distances.

Conclusions: Full tendon transposition augmented with posterior intermuscular suture and recession-resection surgery was effective for a patient with MED associated with significant horizontal deviation, and a second operation was easily performed when overcorrection occurred.

Fig. 1

(a) Photograph of a patient with monocular elevation deficiency associated with significant exotropia. Preoperatively 56 PD right hypotropia and 45 PD right exotropia (Top). Postoperatively 18 PD left hypertropia and 10 PD right esotropia (Bottom). (b) Treatment of the condition with full tendon transposition augmented with posterior intermuscular suture and right lateral rectus muscle recession-right medial rectus muscle resection.