Session: Poster session B
Bilateral Vertical Rectus Transposition with Foster Modification in the Management of Abducens Nerve Palsy
Introduction
Abducens nerve palsy is the most prevalent isolated oculomotor palsy observed in adults. This condition results in esotropia primarily due to the unbalanced activity of the antagonising medial rectus muscle, manifesting most commonly as horizontal uncrossed diplopia. Within the spectrum of surgical techniques available, vertical rectus transposition enhanced by the Foster modification offers a targeted approach, particularly when there's a lack of functionality in the lateral rectus muscle.
Methods
We present a case report detailing the surgical management of chronic traumatic bilateral abducens nerve palsy.
Results
A 66-year-old patient visited the outpatient clinic, reporting a history of head trauma from a car accident six years prior. Since the incident, he has experienced horizontal diplopia. Ophthalmological assessment revealed a 26 prism diopter (PD) esotropia in the right eye (OD) and a 50 PD in the left eye (OS). Both eyes exhibited a limitation in abduction, marked at -4, with no movement beyond the midline and a pronounced horizontal left torticollis was evident. The patient underwent bilateral full tendon vertical rectus transposition complemented by a posterior augmentation suture, using the Foster Modification, coupled with a botulinum toxin injection into the medial rectus.
One month post-surgery, notable improvement was observed. The patient had significant correction in primary gaze with no deviation, the abduction limitation decreased to -3 in OD and -1 in OS.
Conclusions
In this case report, we detailed the surgical intervention for a 66-year-old patient with chronic traumatic bilateral abducens nerve palsy. The patient underwent bilateral full tendon vertical rectus transposition with the Foster Modification and medial rectus botulinum toxin injection. One month post-surgery, significant improvements were evident: primary gaze corrected without deviation and abduction limitations decreased . No signs of torticollis were detected.
Abducens nerve palsy is the most prevalent isolated oculomotor palsy observed in adults. This condition results in esotropia primarily due to the unbalanced activity of the antagonising medial rectus muscle, manifesting most commonly as horizontal uncrossed diplopia. Within the spectrum of surgical techniques available, vertical rectus transposition enhanced by the Foster modification offers a targeted approach, particularly when there's a lack of functionality in the lateral rectus muscle.
Methods
We present a case report detailing the surgical management of chronic traumatic bilateral abducens nerve palsy.
Results
A 66-year-old patient visited the outpatient clinic, reporting a history of head trauma from a car accident six years prior. Since the incident, he has experienced horizontal diplopia. Ophthalmological assessment revealed a 26 prism diopter (PD) esotropia in the right eye (OD) and a 50 PD in the left eye (OS). Both eyes exhibited a limitation in abduction, marked at -4, with no movement beyond the midline and a pronounced horizontal left torticollis was evident. The patient underwent bilateral full tendon vertical rectus transposition complemented by a posterior augmentation suture, using the Foster Modification, coupled with a botulinum toxin injection into the medial rectus.
One month post-surgery, notable improvement was observed. The patient had significant correction in primary gaze with no deviation, the abduction limitation decreased to -3 in OD and -1 in OS.
Conclusions
In this case report, we detailed the surgical intervention for a 66-year-old patient with chronic traumatic bilateral abducens nerve palsy. The patient underwent bilateral full tendon vertical rectus transposition with the Foster Modification and medial rectus botulinum toxin injection. One month post-surgery, significant improvements were evident: primary gaze corrected without deviation and abduction limitations decreased . No signs of torticollis were detected.