Vertical rectus transpositions in sixth nerve palsies

Purpose of review There are many surgical options to address a sixth nerve palsy including transpositions of the vertical recti to the lateral rectus. This review will summarize the results from variations on transpositions as they apply to sixth nerve palsies. Recent findings Transposition of both vertical recti with posterior fixation creates the greatest correction of esotropia in primary position with largest field of single vision. Transposition of the superior rectus alone preserving anterior segment circulation achieves effects similar to transposition without posterior fixation. Augmentation with partial transposition also creates similar improvement in esotropia with possibilities for adjustable sutures and circulation preservation. Summary These various options on transpositions allow options to specifically address surgeon preferences and patient needs to select the appropriate surgery.