ABSTRACT
Purpose: To report the effect on ductions in opposing gaze following total or partial horizontal rectus muscle transposition augmented with posterior fixation sutures to treat vertical gaze misalignment due to cyclovertical muscle palsies. Methods: We reviewed the records of 5 patients who underwent horizontal rectus muscle transposition augmented with posterior fixation sutures for treatment of vertical gaze misalignment secondary to cyclovertical muscle palsy. Results: Four patients achieved excellent alignment in the primary position after 1 operation. One patient required additional surgery for residual deviation with excellent final alignment in the primary position. Ductions in the direction of the palsied muscle improved in all patients. Four patients (80%) developed significant limitation of vertical gaze in the direction opposite that of the palsied muscle.Conclusion: Transposition surgery augmented with posterior fixation is effective in managing vertical misalignment secondary to cyclovertical muscle palsy, improving alignment in the primary position and producing improvement of eye rotation in the direction of the paralyzed muscle. This procedure, however, can produce considerable limitation of ductions in the direction opposite to that of the paralyzed muscle.
