History58 year old man with Grave's orbitopathy. Had previous bilateral orbital decompressions. Has very limited visual function and mobility because of extreme convergence and extremely limited motility of both eyes.
OR #1- Transnasal endoscopic (L) medial rectus recession
OR #2 - (L) medial rectus re-recession to 15 mm posterior to limbus; (L) inferior rectus recession 8 mm
OR #3 - Transnasal endoscopic (R) medial rectus recession
OR #4 - (R) medial rectus re-recession (maximal); (R) inferior rectus recession 8 mm
VIDEO :Transnasal endoscopic medial rectus recession
Transnasal and transethmoidal exploration of (L) medial rectus. Cauterization and excision of orbital fat and scar tissue. Placement and fixation of 6-0 vicryl suture in medial rectus muscle. Passage of suture to anterior orbit and retrieval of muscle anteriorly. Resuturing of medial rectus to globe nasally, in recessed position.