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Vertical rectus muscle union combined with lateral rectus plication for complete abducens nerve palsy

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The aim of this study was to report our postoperative results concerning the vertical rectus (VR) muscle union combined with lateral rectus (LR) plication for the treatment of large-angle esotropia (ET) in complete abducens nerve palsy.


Medical records from 36 patients who had undergone the VR union procedure for ET treatment due to sixth-nerve palsy between July 2014 and July 2018 at Beyoglu Eye Research and Training Hospital were reviewed. One week before surgery, all patients underwent a 4-IU botulinum toxin A (btx) injection into the ipsilateral medial rectus (MR). All patients then underwent a VR muscle union procedure. A non-absorbable suture was inserted through the lateral muscular margin of each VR muscle at approximately 1/5 the width from the edge at 10 mm distance from the VR insertion. Both sutures were then tied to each other above the LR. Plication of the LR muscle using a non-absorbable suture was performed in all cases.


The study population consisted of 14 (38.9%) females and 22 (61.1%) males. The mean age was 36.31 ± 19.16 years. The mean preoperative deviation angle in primary gaze into distance was 47.77 ± 18.48 prism diopter (PD). The mean deviation angle 1 year after surgery was − 1.0 ± 6.62 PD. Abduction improved from − 4.27 ± 0.46 to − 1.88 ± 0.96.


The VR muscle union in combination with LR plication appears to be an effective treatment procedure for complete abducens nerve palsy patients.

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Correspondence to Asli Inal.

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Inal, A., Gokyigit, B., Ocak, O.B. et al. Vertical rectus muscle union combined with lateral rectus plication for complete abducens nerve palsy. Int Ophthalmol 40, 423–429 (2020).

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