case_images: PMC4327550_01
case_images: Preoperative ocular motility photographs of the patient in the nine gaze positions. The right eye revealed marked hypertropia and completely restricted downward movement.
case_images: cop-0006-0001-g01.jpg
case_images: PMC4327550_01_cop-0006-0001-g01.jpg
case_images: F1
case_images: The right eye showed marked hypertropia and completely restricted downward movement (fig. 1).
case_images: Anterior segment photographs of the right (a) and left eye (b). Microcornea and iris coloboma were present in both eyes.
case_images: cop-0006-0001-g02.jpg
case_images: PMC4327550_01_cop-0006-0001-g02.jpg
case_images: F2
case_images: Microcornea and iris coloboma were also present in both eyes (fig. 2).
case_images: 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).
case_images: cop-0006-0001-g03.jpg
case_images: PMC4327550_01_cop-0006-0001-g03.jpg
case_images: F3
case_images: 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.
case_images: Operative findings. The right inferior rectus muscle was confirmed to be absent.
case_images: cop-0006-0001-g04.jpg
case_images: PMC4327550_01_cop-0006-0001-g04.jpg
case_images: F4
case_images: Moreover, it was confirmed that the right inferior rectus muscle was absent (fig. 4).
case_images: 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.
case_images: cop-0006-0001-g05.jpg
case_images: PMC4327550_01_cop-0006-0001-g05.jpg
case_images: F5
case_images: 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).
case_images: Postoperative ocular motility photographs of the patient in the nine gaze positions. The right eye revealed hypotropia and improved downward movement.
case_images: cop-0006-0001-g06.jpg
case_images: PMC4327550_01_cop-0006-0001-g06.jpg
case_images: F6
case_images: Postoperatively, the right eye showed hypotropia and improved downward movement (fig. 6).