Muscle transposition surgery
1) Transposition of the rectus muscles to treat A or V pattern strabismus:
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A and V pattern strabismus that occurs in the absence of oblique muscle dysfunction can be
corrected by transposing or offsetting the rectus muscles undergoing surgery. Offsetting the
muscle weakens the effect of that muscle when the eye is moved in the direction in which it is
offset.
2) Full tendon transposition:
- Indication: to treat severe paralysis of any rectus muscle, although it is used most commonly
to treat lateral rectus muscle palsy by transposing the superior and inferior rectus muscles
laterally.
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Technique:
To perform the full tendon transposition procedure, the surgeon must first make an incision in
the conjunctiva, and then access the muscles to be transposed, which would be the inferior
and superior rectus muscles in the case of a lateral rectus muscle palsy.
The intermuscular septum is then dissected free for 12–15 mm.
Once the muscles have been detached from their insertions, they are moved laterally. The
temporal border of the superior rectus muscle is sutured to the superior border of the lateral
rectus muscle, and the temporal border of the inferior rectus muscle is sutured to the inferior
border of the lateral rectus muscle. The muscles are generally positioned along the spiral of
Tillaux.
Augmentation: by attaching a portion of the transposed muscle to the sclera with a posterior
fixation suture or to the belly of the paretic muscle
3) Partial tendon transposition:
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They are alternative to the full tendon transposition to treat severe muscle paresis that reduce
the likelihood of anterior segment ischemia
 Jensen procedure:
The superior, inferior, and lateral rectus muscles are split
longitudinally into two halves extending 12 to 15 mm posteriorly.
The nasal anterior ciliary arteries of the vertical rectus muscles
are left intact, and the temporal portions of the superior and
inferior rectus muscles are joined with a non-absorbable 6-0
suture to the superior and inferior portions of the lateral rectus
muscle.
Since this procedure spares a portion of the ciliary vasculature,
simultaneous recession of the medial rectus muscle can be
performed with less risk of anterior segment ischemia.
 Hummelsheim procedure:
suturing the transposed portions of the superior and inferior rectus
muscles directly to the lateral rectus muscle at its insertion or to the
sclera adjacent to the lateral rectus muscle insertion
Augmentation: by resection of 4–5 mm of the transposed muscle
half prior to attaching the muscle to the sclera, or by suturing the
transposed superior and inferior rectus muscles to the lateral edge
of the lateral rectus muscle ≥10 mm posterior to its insertion (lateral
fixation).
4) SO tendon transposition:
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Indication: total cranial nerve III palsy
Technique:
Usually combined with a large lateral rectus muscle recession and
medial rectus muscle resection to attempt to reposition the eye
centrally.
The superior rectus muscle is approached nasally, through either a
limbal or a superonasal fornix incision.
The superior oblique muscle tendon is transected near the nasal
border of the superior oblique muscle.
The eye is adducted, and the tendon is sutured to the sclera at the
superior border of the medial rectus muscle.
Some surgeons fracture the superior oblique trochlea prior to
suturing the tendon to the sclera.
5) Inferior oblique muscle transposition:
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This procedure is used to treat severe incyclotorsion after macular
translocation surgery. It is also known as inferior oblique muscle
advancement.