BACKGROUND: This study aims to assess the surgical outcomes of lateral rectus muscle paralysis patients who received superior rectus transposition (SRT) surgery or SRT with augmented suture (SRTA). METHODS: This case series study enrolled 11 lateral rectus muscle paralysis patients who underwent SRT or SRTA from April 2014 to June 2022 at Wuhan Bright Eye Hospital. Preoperative and postoperative assessments included the following parameters: (1) eye position in primary gaze
(2) ocular motility
(3) presence of diplopia
and (4) compensatory head positioning. RESULTS: Six cases received SRT, and 5 cases received SRTA. Preoperative esodeviation showed a mean angle of + 57.27 ± 9.62 prism diopters (PD), and the angle reduced to + 7.45 ± 2.70, + 6.36 ± 2.67, and + 3.09 ± 3.34 PD at 1 month, 6 months, and 12 months, respectively. At postoperative 12 months, 10 out of 11 cases achieved a significant reduction in internal oblique deviation, resulting in the elimination of abnormal head positioning and initial eye position diplopia. The range of motion of the affected eye was also improved by the surgical procedure, significantly enhancing the external rotation compared to preoperative values. No significant vertical or torsional strabismus was observed after surgery. Stable eye positions and remarkable treatment outcomes were revealed by follow-up evaluations conducted between 12 and 18 months postoperatively. CONCLUSIONS: Internal rectus migration combined with transposition of the superior rectus muscle may be feasible for treating lateral rectus muscle paralysis. The eye position, abduction function, and binocular vision function were improved in patients who received SRT or SRTA.