Inferior oblique transposition for large hypertropia after vertical rectus transposition.

Consecutive vertical deviations occur in 13% to 30% of cases after full tendon vertical rectus transposition (VRT) surgery in adult patients with abducens nerve palsy. We report a 7-year-old boy with congenital abducens nerve palsy who developed a large hypertropia following VRT with posterior fixation sutures. During subsequent surgery, extensive scarring of the vertical rectus muscles was observed, and an inferior oblique nasal anterior transposition was performed. The patient was orthotropic in primary position through 18 months of follow-up. The causes and management options for vertical deviation following VRT are discussed.