A new application of modified Nishida muscle transposition procedure for medial rectus muscle transection following endoscopic sinus surgery without tenotomy or splitting muscles

Kong, Miao; Zhang, Li Jun; Dai, Shuan; Li, Jun Hong

doi:10.1016/j.jaapos.2019.05.011

Cited by 5 publications

(2 citation statements)

References 4 publications

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“…This suggests effectiveness and safety of the modified Nishida procedure in treating complicated cases of chronic paralytic strabismus. 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 ).…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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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“…This vessel-sparing technique also allows for equilateral weakening of the medial rectus muscle. [15] wurde sie auch bei Funktionsverlust des M. rectus medialis [11,12] und bei Heberparese [13] durchgeführt.…”

Section: Introductionunclassified

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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Incidence, Management, and Outcome of Pulled-in-Two Syndrome Associated With Strabismus Surgery

Kong¹,

Han²,

Li³

et al. 2023

J Pediatr Ophthalmol Strabismus

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Purpose: To report the incidence and outcomes of pulled-in-two syndrome during strabismus surgery and investigate the clinical features and management of the disease. Methods: The medical records of patients who underwent strabismus surgery and developed pulled-in-two syndrome between July 2013 and October 2020 were reviewed retrospectively. The demographic characteristics, intraoperative details (including surgery type and management), and subsequent and final outcomes were extracted from the records. Results: Of the 11,824 strabismus surgeries during the study period, 4 cases of pulled-in-two syndrome were documented, accounting for an overall incidence of 0.034%. The average age of the patients with pulled-in-two syndrome was 61.75 ± 8.99 years. All 4 patients were women; 2 had abducens nerve palsy and the other 2 had myopic strabismus fixus. The inferior rectus muscle was involved in 1 patient and the medial rectus muscle was involved in 3 patients. All of the involved extraocular muscle was lost. One patient achieved orthotropia, and the others were undercorrected after the surgery. Conclusions: Pulled-in-two syndrome is one of the rarest and most severe complications of strabismus surgery. Cranial nerve palsy, advanced age, prior surgery, thyroid-associated ophthalmopathy, and degenerative conditions of the extraocular muscle are risk factors for pulled-in-two syndrome. Therefore, the prevention of pulled-in-two syndrome in patients with these risk factors should be investigated further. [ J Pediatr Ophthalmol Strabismus . 20XX;X(X):XX–XX.]

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A new application of modified Nishida muscle transposition procedure for medial rectus muscle transection following endoscopic sinus surgery without tenotomy or splitting muscles

Cited by 5 publications

References 4 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

Augenmuskeltransposition nach Nishida bei Abduzensparese

Incidence, Management, and Outcome of Pulled-in-Two Syndrome Associated With Strabismus Surgery

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