AIM: To investigate the application of rectusmuscle transplantation optimization in the treatment of refractory supraventricular insufficiency in one eye caused by double supraventricular paralysis with inferior rectus restriction and high original vertical strabismus.

METHODS: Retrospective analysis was performed on 6 cases of double superior muscle palsy admitted to our hospital from January 2015 to January 2019. After the failure of conservative treatment, rectus muscle transplantation optimization was adopted to observe the improvement of preoperative and postoperative eye position, vertical strabismus, motor function of upper and lower rotation of paralytic eye, as well as the improvement of pseudo ptosis and compensated head position.

RESULTS: After the restriction was lifted, rectusmuscle transplantation optimization was performed. The original in situ vertical strabismus degree before surgery, one month and six months after surgery were(49.83 ± 6.55)PD,(2.67±2.07)PD, and(1.83±2.40)PD. There was a significant difference in vertical strabismus before and after 1mo and 6mo of operation(P<0.001). There was no significant difference in the comparison of vertical strabismus between 1mo and 6mo of operation(P=0.899). All patients had the orthotopic position in postoperative position, and the paralysis function of the paralyzed eyes improved significantly after the operation; Pseudopterygoptosis in four cases and compensatory head position in two cases before operation were significantly improved after operation.

CONCLUSION: Optimization of rectus muscle transplantation is suitable for unilateral superior rotation deficiency with limitation of inferior rectus, which can effectively improve the superior rotation function of affected eye with stable curative effect.