PMC4327550_01
Preoperative ocular motility photographs of the patient in the nine gaze positions. The right eye revealed marked hypertropia and completely restricted downward movement.
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F1
The right eye showed marked hypertropia and completely restricted downward movement (fig. 1).
Anterior segment photographs of the right (a) and left eye (b). Microcornea and iris coloboma were present in both eyes.
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F2
Microcornea and iris coloboma were also present in both eyes (fig. 2).
a Coronal T1-weighted MRI revealed the absence of the inferior rectus muscle in both eyes. Sagittal T1-weighted MRI revealed the absence of the inferior rectus muscle in the right (b) and left (c) eye. The optic nerve was also displaced inferiorly (arrows in a-c).
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F3
Coronal T1-weighted magnetic resonance imaging (MRI) revealed the absence of inferior rectus muscles in both eyes (fig. 3a), which was also confirmed by sagittal T1-weighted MRI (fig. 3b, c). Furthermore, the optic nerve was displaced inferiorly (arrows in fig. 3a-c); therefore, we diagnosed the marked hypertropia as aplasia of the inferior rectus muscle.
Operative findings. The right inferior rectus muscle was confirmed to be absent.
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F4
Moreover, it was confirmed that the right inferior rectus muscle was absent (fig. 4).
Operative finding (left panel) and schematic interpretation of the muscle transposition procedure (right panel). The sutures were passed through the inferior margins at a distance of 8 mm behind each horizontal rectus muscle insertion. Each horizontal rectus muscle was transposed to the putative inferior rectus muscle insertion point (right panel; dashed line) 7 mm from the limbus and anchored onto the sclera (left panel; arrows). Abbreviations: MR = medial rectus muscle; LR = lateral rectus muscle; SR = superior rectus muscle.
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F5
A superior rectus muscle tenotomy was also performed (fig. 5). Regrettably, however, surgical correction was not effective; therefore, we retransposed each horizontal rectus to the putative inferior rectus muscle insertion (fig. 5; right panel; dashed line) 7 mm from the limbus (fig. 5; left panel; arrows).
Postoperative ocular motility photographs of the patient in the nine gaze positions. The right eye revealed hypotropia and improved downward movement.
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F6
Postoperatively, the right eye showed hypotropia and improved downward movement (fig. 6).