Plication-Augmented Modified Nishida's Procedure for Large-Angle Esotropia: A Case Series.

Area of Science:

• Ophthalmology
• Strabismus Surgery
• Neuro-ophthalmology

Background:

• Long-standing complete sixth nerve palsy often results in large-angle esotropia.
• Conventional treatments may involve multiple surgical stages or carry risks like anterior segment ischemia.

Purpose of the Study:

• To evaluate the efficacy of a combined modified Nishida's procedure with medial rectus recession and lateral rectus plication.
• To assess surgical outcomes for patients with chronic sixth nerve palsy and large-angle esotropia.

Main Methods:

• Retrospective interventional case series.
• Inclusion of three patients with chronic traumatic complete sixth nerve palsy and large-angle esotropia (70-75 PD).
• Surgical intervention using a combined modified Nishida's procedure, medial rectus recession, and lateral rectus plication.

Main Results:

• Two out of three patients achieved orthophoria at distance and near postoperatively.
• One patient had a small residual esotropia of 5 PD at 6 months follow-up.
• The technique provided substantial alignment correction and improved abduction.

Conclusions:

• The combined modified Nishida's procedure with medial rectus recession and lateral rectus plication is an effective single-stage surgical approach.
• This technique effectively manages large-angle esotropia associated with complete sixth nerve palsy.
• Offers benefits including improved abduction, resolution of diplopia, and a lower risk of anterior segment ischemia compared to vertical rectus transposition.