Surgery to Treat Residual Acquired Excyclotropia without Changing the Primary Position Vertical Deviation: A Case Report

Aim: To describe the surgical management and long-term outcome of a case of symptomatic residual acquired primary position excyclotropia, without changing the primary position vertical deviation.

Methods: This case report describes ipsilateral half tendon width transpositions of the left superior rectus temporally and inferior rectus nasally, combined with right inferior rectus posterior fixation suture at 11 mm.

Results: Three days postoperatively, the transposition procedure produced a 10° cyclotorsional change in primary position, resulting in 5° of incyclotorsion (double Maddox rod). Six weeks postoperatively, the incyclotorsion regressed to 1° (synoptophore) and a central field of binocular single vision (BSV) (90° horizontally and 60° vertically) was demonstrated without an abnormal head posture. Fifteen months postoperatively, 1° primary position incyclotorsion (Torsionometer) and the central field of BSV remained stable. The primary position vertical deviation was changed by 1 prism diopter and no V pattern was induced.

Conclusion: In our case, ipsilateral half tendon width horizontal transpositions of the vertical recti achieved satisfactory correction of excyclotorsion and restored BSV without significantly changing the primary position vertical deviation. The result was stable 15 months postoperatively.