Successful surgical management of sixth nerve palsy by transposition of a previously snapped and retrieved inferior rectus muscle

Purpose: To report a case of intraoperative rupture of inferior rectus muscle, which was retrieved and later successfully transposed for management of sixth nerve palsy. Methods: Case report. Results: A 36-year-old woman presented with traumatic right sixth nerve palsy and esotropia following a car accident five years earlier. During the originally planned vertical transposition surgery, the inferior rectus muscle snapped, but was retrieved and resutured to the sclera 3 mm posterior to the original insertion. After a few months, the second attempt of transposition of vertical recti (including the previously snapped and reattached inferior rectus) was successful, and the patient achieved satisfactory postoperative alignment. Conclusions: Intraoperative rupture of an extraocular muscles is a rare and serious complication encountered during strabismus surgery. However, if successfully retrieved, this muscle has still the chance of future re-operation.