To the Editor.
—In their article in the June 1989 issue of the Archives, Rosenbaum et al1 advocated vertical rectus muscle transposition surgery in conjunction with botulinum toxin (Oculinum) injection of the medial rectus muscle for esotropia as a result of abducens palsy. They suggested moving the superior and inferior recti muscles temporally to lie adjacent to the lateral rectus muscle. They gave a very detailed description of the placement of these muscles. They were using botulinum toxin either before, during, or after surgery in this group of patients.In light of their results, I attempted this procedure but found that I induced vertical deviations at the time of the botulinum toxin injection. I am aware of the fact that injection of the medial rectus muscle with botulinum toxin may induce a vertical deviation as well; however, I detected these vertical deviations at the time of the transposition and
Scott WE. Vertical Rectus Muscle Transposition Surgery Modified. Arch Ophthalmol. 1991;109(10):1345–1346. doi:10.1001/archopht.1991.01080100025014
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