Hummelsheim procedure combined with medial rectus recession in complete sixth nerve palsy and esotropic Duane Retraction Syndrome

Purpose: To evaluate the effect of half tendon vertical rectus muscle transposition (HVRT) combined with medial rectus muscle recession (MRrec) in complete sixth nerve palsy (CSNP) and esotropic Duane Retraction Syndrome (eDRS). Methods: A retrospective study of patients with unilateral CSNP or eDRS who underwent HVRT combined with medial rectus recession over the course of 18 years. The patients with previous strabismus surgery and follow up less than 3 months were excluded. Overcorrection was defined as any amount of exotropia, and undercorrection was defined as residual esotropia of > 10 prism diopter (PD). Results: A total of 39 patients were enrolled including 22 CSNP and 17 eDRS patients. Esotropia improved from 45.8 +/- 22 and 22.5 +/- 6.4 PD to 0.8 +/- 2.5 and 0.3 +/- 1 PD in CSNP group and eDRS group respectively. The angle of face turn improved from 34.3 +/- 8.4 degrees and 26.5 +/- 9 degrees to 0.6 +/- 2.4 degrees and 0.8 +/- 1.6 degrees in the CSNP group and eDRS group respectively. Abduction limitation improved from -4.5 +/- 0.5 and -4 +/- 0 units to -2.9 +/- 0.5 and -2.7 +/- 0.5 units in CSNP group and eDRS group respectively. No patient developed a new vertical deviation. An overcorrection occurred in one patient of the eDRS group who improved after botulinum toxin injection in the ipsilateral lateral rectus muscle. Undercorrection was seen in two patients. Conclusion: HVRT combined with MRrec is an effective procedure to improve esotropia, face turn, and abduction limitation in CSNP and eDRS.