Adjustable Vertical Rectus Muscle Transposition Surgery

To the Editor. —I and my coauthors1recently published an article advocating vertical rectus muscle transposition surgery and botulinum toxin injection of the medial rectus muscle for esotropia as the result of abducens palsy. In that series of 10 patients, one patient developed a hypertropia induced by full tendon vertical rectus muscle transposition surgery and required an additional surgical procedure to reposition the transposed superior rectus and relieve the hypertropia. Recently, I modified my surgical procedure in patients older than 12 years to permit postoperative adjustment of the vertical rectus muscles if an induced vertical deviation is detected in the immediate postoperative period. A circumferential conjunctival incision is made between the superior border of the lateral rectus muscle and the lateral border of the superior rectus muscle 7 mm posterior to the limbus. The superior rectus insertion is isolated through this incision. The intramuscular septum and attachments to the superior