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

To report a case of intraoperative rupture of inferior rectus muscle, which was retrieved and later successfully transposed for management of sixth nerve palsy.
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.
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.