A Case of Nishida Muscle Transposition Procedure for Abducens Palsy

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 glaucomatous 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. CONCLUSIONS: The Nishida muscle transposition is a simple procedure and prevents postoperative risk of anterior segment ischemia without the occurrence of tenotomy and muscle splitting. We report a successful Nishida muscle transposition procedure in a patient with chronic abducens palsy.