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Abstract
Purpose
Herein we report a successful Nishida muscle transposition procedure (modified Jensen procedure) with right medial rectus recession for treating a right abducens palsy patient.
Case summary
A 63-year-old male presented with a 30-year history of esotropia due to traumatic abducens palsy in his right eye. At initial examination, right eye visual acuity was 0.9 and intraocular pressure was 11 mm Hg. Ocular movement of the right eye was restricted in the lateral direction and prism cover-uncover test revealed 75 prism diopter right esotropia. For 2 years, the patient was treated as normal tension glaucoma and used his right eye as the dominant eye by turning his head due to glaucom-atous field defect in the left eye. We performed 8.0 mm medial rectus recession and Nishida muscle transposition procedure in the right eye and inserted a suture through the temporal margin of each vertical rectus muscle. One week after surgery, the right eye maintained relatively straight alignment and prism cover-uncover test showed 20 prism diopter residual esotropia in the left eye.
References
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Figure 1.
Preoperative nine cardinal photographs showing approximately 75 prism diopters of right esodeviation (center) and limi-tation of abduction of right eye (left middle).
Figure 2.
(A) Humphrey automated visual field examination of right eye. (B) Humphrey automated visual field examination of left eye showing more severe glaucomatous field defect. POS = positive; NEG = negative; SITA = Swedish interactive threshold algo-rithm; GHT = glaucoma hemifield test; VFI = visual field index; MD = mean deviation; PSD = pattern standard deviation.
Figure 3.
(A) Diagram showing the muscle transposition procedure of Nishida. (Left) Suture the sclera and vertical rectus muscle where the same colored arrows are pointing. (Right) Superior rectus muscle is transposed to supero-laterally (red arrow) and inferior rectus muscle is transposed to infero-laterally (blue arrow). (B) Our intraoperative image of modified Jensen (Nishida’s) procedure. A 5-0 pro-lene suture was inserted through each temporal margin of vertical recti at approximately one third of the width from the edge at a dis-tance of 8.0 mm behind the insertion (blue arrow). The same suture also was inserted through each scleral wall at a distance of 12.0 mm behind the limbus at the superotemporal or inferotemporal quadrant (red arrow). Then, the lateral margin of each vertical rectus muscle was transposed superotemporally or inferotemporally and sutured to the sclera. LR = lateral rectus muscle; SR = superior rectus mus-cle; MR = medial rectus muscle; IR = inferior rectus muscle.
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