Surgical treatment of vertical deviation in Möbius syndrome

PURPOSE: To report the surgical outcomes of the treatment of vertical deviation in patients with Möbius syndrome. METHODS: A retrospective review of the medical records of patients diagnosed with Möbius syndrome treated at the Ricardo Gutiérrez Children's Hospital between 2010 and 2024 was performed. Age, sex, and horizontal and vertical ocular deviations before and after surgery were recorded. Ocular deviation was measured using the alternate prism and cover test or Krimsky test according to patient cooperation. RESULTS: Sixty-two children were included, of whom 18 underwent surgical treatment. Most surgically treated patients presented with esotropia and were managed with bilateral medial rectus recession, with a mean recession of 7 mm (range: 4-12 mm). The mean preoperative horizontal deviation was 53 prism diopters (PD) of esotropia (range: 25-70 PD). Only 2 of 62 patients presented with exotropia. Vertical deviation was clinically evident in 14 of 62 patients, but only 5 underwent surgical correction. In all surgically treated cases, the vertical deviation corresponded to dissociated vertical deviation (DVD). One patient underwent bilateral superior rectus recession combined with horizontal surgery, one patient underwent unilateral superior rectus recession, and three patients underwent inferior rectus plication as a second procedure, achieving excellent postoperative alignment. CONCLUSIONS: Although esotropia with bilateral abduction limitation represents the predominant pattern in Möbius syndrome, vertical deviation is clinically evident in almost one quarter of patients. Inferior rectus plication proved to be a safe and effective technique for the surgical resolution of hypertropia in these cases.