Muraki and associates deserve appreciation for describing a new procedure in the article Surgical Results of a Muscle Transposition Procedure for Abducens Palsy Without Tenotomy and Muscle Splitting. However, the success they claim regarding improvement in range of movements requires further deliberation. Considering Figure 3, in which comparison has been made between pre- and postoperative results, adduction of the left eye in right gaze is less in preoperative than in postoperative eyes. In fact, preoperatively, both eyes are in dextrodepression position instead of true right gaze in a horizontal line, which has induced a narrowing of the palpebral fissure in both eyes preoperatively as compared to postoperatively. Thus, preoperatively, less forceful movement of both eyes in right gaze has resulted in an abduction deficit in the right eye, which has been claimed to improve postoperatively.

Moreover Figure 4 describes binocular single vision of patient 7 to be 30 degrees in right gaze. However, in Figure 3, postoperative right gaze shows 2 points going against this claim. First, right-eye abduction is less than 30 degrees; and second, left-eye adduction is more than 30 degrees, making it impossible to achieve binocular single vision. In fact, it is difficult for vertical muscles to produce horizontal movement (abduction) that matches the movement of a normal yoke muscle. This would also apply to patients 2 and 4.

In the Results section, it was mentioned that “Four of the 9 patients (patients 2, 4, 6, and 7) regained the field of binocular single vision….” Instead of the word regained , they should have used the term partially improved .

In spite of the difference of opinion, we congratulate authors for their work.