Full vertical rectus muscle transposition combined with medial posterior fixation sutures for patients with adduction deficiency

Purpose: To compare the surgical and functional results of full tendon rectus muscle transposition to the medial rectus muscle augmented with posterior medial fixation sutures in patients with adduction deficiency (ADD) and Duane's syndrome type 2. Design: Retrospective nonconcurrent interventional comparative case series. Participants: Twelve consecutive patients with ADD and Duane's syndrome type 2. Interventions: Six patients treated by the full tendon rectus muscle transposition procedure alone were compared with 6 patients treated by the full tendon rectus muscle transposition combined with posterior medial fixation sutures. Main Outcome Measures: Postoperative ocular alignment, duction improvement, binocular functions, and reoperation. Results: In the augmented surgery group, mean distance and near deviation decreased by 74.5% and 74%, respectively, versus 56% and 59%, respectively, in the control group (P = 0.007 and 0.02, between-group comparison for distance and near deviation, respectively). Mean duction improved in 73% of the study group compared with 52% of controls (P = 0.025). No postoperative complications or duction anomalies were observed during follow-up in the entire cohort; reoperation was needed in 1 patient in the study group and in all 6 patients in the control group. Conclusions: The augmented full vertical rectus muscle procedure is a beneficial surgical approach for patients with ADD and Duane's retraction syndrome type 2, reducing the need for multiple extraocular muscle surgery.