Session: Poster session B

Outcomes of modified Nishida procedure in sixth nerve palsy

INTROUDCTION: To evaluate the motor outcomes and the changes in the palpebral fissure after modified Nishida procedure in unresolving sixth nerve palsy



METHODS: A retrospective chart review was conducted on patients who had modified Nishida procedure for unresolving sixth nerve palsy. The operative details including the exact position of sutures were recorded. Ductions, versions, angles of misalignment, and changes in palpebral fissure were tabulated.



RESULTS: A total of 35 patients were identified. Mean age was 25.3 ± 19.4 years. Trauma was the most common cause (25 patients, 71%). Mean preoperative angle of deviation in unilateral cases (n=33) was 44 ± 7 PD (range, 25 to 60 PD). Two cases had bilateral nerve palsy with a preoperative angle of 90 PD. Two cases had prior medial rectus recession. Medial rectus recession was performed in all other cases (mean recession, 4.6 ± 1.1 mm). Mean follow-up was 10.1 ± 9.0 months (range, 3 to 48 months). Initial overcorrection > 15 PD occurred in 8 cases (23%) and resolved completely over follow-up in 6 cases. Residual esotropia > 8 PD occurred in 4 cases (11%), all had a more proximal suture placement. There was no relationship between the amount of medial rectus recession and the risk of undercorrection. Final success rate was 83%. Mean postoperative angle at last follow-up was 1 ± 6 PD (range, XT 15 PD to ET 20 PD). Induced vertical deviation occurred in 3 patients but resolved completely in2 patients. Mean postoperative abduction deficit was -2.7 ± 0.8 (range, -1 to -4). Narrowing of palpebral fissure > 1 mm occurred in 8 cases (23%).



CONCLUSIONS: Modified Nishida procedure is an effective and self-adjusting procedure for the management of sixth nerve palsy. Care should be taken to properly place the sutures to reduce the risk of residual undercorrection.