No split, no tenotomy transposition procedure for complete abducens palsy

Murthy, Sowmya Raveendra

doi:10.4103/ijo.ijo_768_16

Cited by 10 publications

(5 citation statements)

References 7 publications

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“…The present case represented a long-term, 35-year palsy in previously operated horizontal muscles with significant scars surrounding the MR and LR muscles and a large angle. Nevertheless, the results were comparable to those reported in other publications [ 3 , 4 , 6 , 8 , 16 , 24 , 25 , 27 ] ( Table 1 ). Furthermore, the current case responded well to BTA even though it is not recommended in palsy cases that have progressed beyond 6 months [ 28 ].…”

Section: Discussionsupporting

confidence: 91%

“…The procedure improves ocular alignment and restores force balance by transposing the superior and inferior rectus muscles [ 26 ]. This method reduces the need for repeat procedures and yields durable results; according to previous reports, there are sixth nerve palsy cases with 9–20 months’ evolution from onset [ 4 , 8 , 16 , 25 ] ( Table 1 ). The present case represented a long-term, 35-year palsy in previously operated horizontal muscles with significant scars surrounding the MR and LR muscles and a large angle.…”

Section: Discussionmentioning

confidence: 96%

“…Depending on passive duction and preoperative horizontal deviation, it is possible to determine the necessity of additional procedures, such as MR muscle recession and BTA, which increase the effect in primary position [ 6 ]. Likewise, the series of patients with complete LR palsy reported by Murthy et al had good outcomes using this technique [ 25 ]. The adjunct procedure in the current case was a BTA injection into the ipsilateral MR muscle.…”

Section: Discussionmentioning

confidence: 99%

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Surgical management of chronic sixth cranial nerve palsy: case report and literature review

Hakimeh,

Shahraki,

Courtois

et al. 2024

Med Hypothesis Discov Innov Ophthalmol

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Background: Esotropia resulting from sixth cranial nerve palsy can substantially impact an individual’s visual acuity and overall quality of life. If the condition does not resolve in 6–10 months, surgical intervention may be necessary. Various muscle surgeries may be considered, with vertical rectus muscle transposition emerging as the primary option for treatment of complete palsy. However, this technique carries the risk of anterior segment ischemia and post-surgery deviations. Herein, we present a successful treatment of chronic complete sixth nerve palsy using a modified Nishida procedure, without splitting or tenotomy, and an adjunct botulinum toxin A (BTA) injection in the ipsilateral medial rectus muscle. Case Presentation: A 59-year-old woman with a history of traumatic sixth nerve palsy had previously undergone horizontal muscle strabismus surgeries. Following multiple left medial rectus recessions, lateral rectus resection, and BTA injections, esotropia persisted. The worsening of her condition led to emotional distress and impaired social interaction. Initial examination revealed marked esotropia and limited left eye abduction. Magnetic resonance imaging (SIGNA MR750w, GE Healthcare, Waukesha, WI, USA) of the left eye revealed a contracted medial rectus muscle and substantial atrophy of the left lateral rectus muscle. A modified Nishida procedure was performed with an injection of 3 units of BTA into the ipsilateral medial rectus muscle, resulting in improved ocular alignment and stable findings after nine postoperative months. Furthermore, we supported our successful outcome with a summary of similar reported cases of sixth nerve palsy managed using the modified Nishida procedure with or without adjunctive procedures. Conclusions: Following the modified Nishida procedure, the patient experienced a reduction in diplopia, improved ocular alignment and stability, and an increased binocular diplopia-free field. This case underscores the importance of an individualized approach to complex strabismus cases and highlights the modified Nishida procedure as a valuable tool in such circumstances. In the future, strabismus management will focus on refining personalized treatment and exploring innovative techniques for complex cases. Our success in using a combination of Nishida procedure and BTA injection should be further investigated in large-scale studies.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Surgical management of chronic sixth cranial nerve palsy: case report and literature review

Hakimeh,

Shahraki,

Courtois

et al. 2024

Med Hypothesis Discov Innov Ophthalmol

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“…14,20,21,19 This might be due to the maximum MR recession we had conducted in all the patients undergoing surgery as the combination of the two procedures had resulted in a better outcome among those with a deviation more than 25 PD. 16 The result we have managed to achieve is even high than those reported by Nishida et al 13 in which vertical rectus muscles were splitted into halves and were sutured to sclera without tenotomy of vertical rectus muscles, Murthy SR et al 22 where modified Nishida's procedure was performed and Park and Oh 14 in which loop muscle reunion procedure was done. This correction was even higher than that achieved after the Hummelsheim procedure.…”

Section: Discussionmentioning

confidence: 76%

Outcome of Jensen Procedure for Complete Abducent Nerve Palsy in Tertiary Eye Hospital of Nepal

Joshi¹,

Suwal

Shrestha³

2023

Nep J Neurosci

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Introduction: Jensen procedure is done for correcting large amount of esotropia and improving abduction in complete abducent nerve palsy. It is a modified form of transposition surgery where the superior, inferior, lateral rectus muscles are split longitudinally and their lateral halves are respectively joined to the superior halves and inferior halves of lateral rectus with non-absorbable sutures. The study was done to find the surgery outcome of Jensen Procedure in complete abducent nerve palsy. Methods and Materials: A retrospective study of complete abducent nerve palsy of greater than six months duration that underwent Jensen Procedure was performed. Preoperative deviation and postoperative deviation at six weeks and three months were measured and analyzed. Clinical photography and diplopia charting of each case was done before surgery, and postoperatively at three months follow up in all cardinal gazes. Results: Eight eyes of eight patients with the mean age 38.50 ± 22.32 years (16 - 83) underwent medial rectus recession with muscle union (Jensen’s) procedure. Three right eyes and five left eyes were operated. The preoperative esodeviation reduced from mean preoperative 74.37±28.21∆ (30 - 120∆) base out to mean post-operative 12±12.29∆ (-8 – 30∆) base out. The abduction deficit improved from mean preoperative -3.75 ± 0.46 (-4 to -3) to postoperative -1.87 ± 0.99 (-3 to 0). All cases were satisfied with their ocular alignment and cosmesis. Conclusion: The Jensen Procedure can successfully correct the large amount of deviation due to complete abducent nerve palsy with improvement in functionality, abduction deficit and cosmesis.

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“…von 24-36 Prismendioptrien (PD) mit der Transposition allein, wohingegen eine zusätzliche gleichseitige Rücklagerung des M. rectus medialis zu einer Reduktion von 50-62 PD führte. Murthy und Kollegen[19] bestätigten diese Resultate in ihrer kleinen Fallserie. Eine Verbesserung der Motilität gelang in allen 3 Patienten mit einer Abduktion über die Mittellinie hinaus.…”

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Augenmuskeltransposition nach Nishida bei Abduzensparese

Heckmann

Todorova

Sturm

2021

Klin Monbl Augenheilkd

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Zusammenfassung Hintergrund Die operative Behandlung von Abduzensparesen orientiert sich vor allem an der verbliebenen Motilität des M. rectus lateralis. Reicht die maximale Abduktion nicht über die Mittellinie hinaus, sollte eine gleichseitige Muskeltransposition der vertikalen Recti erfolgen. Seit der Erstbeschreibung vor mehr als 100 Jahren sind eine Vielzahl von Modifikationen vorgestellt worden. Die minimalinvasive Adaptation nach Nishida hat zuletzt zunehmend Beachtung erfahren. Patienten und Methoden Retrospektive Fallserie von 4 Patienten mit Abduzensparesen, deren chirurgische Versorgung mittels Transpositionsmanöver nach Nishida erfolgte. Die Kasuistiken werden unter besonderer Berücksichtigung der prä- und postoperativen Verhältnisse hinsichtlich Schielwinkel und Motilität präsentiert. Ergebnisse Vier Patienten (2 weiblich, 2 männlich) wurden in die Studie eingeschlossen. Bei einem 7-jährigen Mädchen und einer 37-jährigen Frau mit linksseitiger Abduzensparese erfolgte eine gleichseitige Transposition. Bei einem 56-jährigen Mann mit linksseitiger Parese und einem 82-jährigen Mann mit Parese rechts wurde die Transposition nach Nishida mit einer gleichseitigen Rücklagerung des M. rectus medialis kombiniert. Bei allen 4 Patienten wurden durch die Operation eine deutliche Verkleinerung des Schielwinkels sowie eine Verbesserung der Motilität erreicht. Schlussfolgerung Die Transposition der Vertikalmotoren ist bei Abduzensparesen als Operationsmethode etabliert. Unter den verschiedenen Modifikationen stellt die Adaptation nach Nishida eine sichere, wirkungsvolle und minimalinvasive Option dar. Die gefäßschonende Technik erlaubt auch die gleichzeitige Schwächung des M. rectus medialis.

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No split, no tenotomy transposition procedure for complete abducens palsy

Cited by 10 publications

References 7 publications

Surgical management of chronic sixth cranial nerve palsy: case report and literature review

Surgical management of chronic sixth cranial nerve palsy: case report and literature review

Outcome of Jensen Procedure for Complete Abducent Nerve Palsy in Tertiary Eye Hospital of Nepal

Augenmuskeltransposition nach Nishida bei Abduzensparese

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