A modified Nishida procedure for management of myopic strabismus fixus

Purpose

To evaluate the outcomes of a novel modification of the Nishida procedure with medial rectus recession (Nishida-MRc) for myopic strabismus fixus (MSF) and to compare this modified procedure with the half Jensen’s union with medial rectus recession (U-MRc).

Methods

The medical records of MSF patients who underwent strabismus surgery at a single institution between January 2017 and June 2022 were retrospectively reviewed. The main outcome measures assessed were postoperative improvements in ocular alignment and motility. Surgical success was defined as horizontal and vertical deviations ≤15^Δ.

Results

A total of 45 patients were included, of whom 39 had no previous strabismus surgery. All but 3 had follow-up ≥8 months. Nishida-MRc, with or without a traction suture (Ts), had a success rate (9/16 [56%]) higher, though not statistically significantly so, than U-MRc with or without Ts (11/29 [38%]). The Nishida-MRc group tended to have less frequent use of Ts (25% vs 52%; P = 0.076), and 94% of these patients had a deviation within 20^Δ, compared with 59% for U-MRc (P = 0.012). In cases with esotropia of ≥123^Δ, final residual esotropia in the Nishida-MRc without Ts (12.40^Δ ± 8.30^Δ) and U-MRc-Ts (19.75^Δ ± 18.62^Δ) groups was significantly lower (P = 0.019) than in the U-MRc without Ts group (63.40^Δ ± 40.83^Δ), and the average correction of esotropia was significantly greater (P = 0.014).

Conclusions

In our study cohort, Nishida-MRc produced a greater effect in the treatment of MSF than U-MRc.