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Double under muscle transposition in long-standing sixth nerve palsy: A case report


 Introduction: To report a case of acquired esotropia after long-standing sixth nerve palsy with double under muscle transposition technique correction.

 Case Report: A 41-year-old male presented with diplopia from an unruptured and thrombosed mid-basilar aneurysm that caused isolated left sixth nerve palsy for 18 months after undergoing surgery. He had left face turn, 66 prism diopters (PD) esotropia of the left eye, and a complete left abduction deficit. To improve a complete sixth nerve palsy, we performed a double-under muscle transposition (DUT) technique, vertical recti [superior and inferior (SR) and (IR)] were transposed under left lateral recuts (LR) muscle along with medical recuts (MR) recession. Following postoperative result at three months, he was found to be orthotropia at near and 8 PD of exotropia at distance. He also improved diplopia in the primary position and he could slightly abduct the left eye. He did not have any postoperative complication.

 Conclusion: We demonstrated that a DUT technique can be a procedure of choice in patients with large angle deviation from paralytic strabismus.
