Abstract

A five year old child with evident right hypertropia came for right eye dense amblyopia.She had a history of familial hypertropia.She was diagnosed with both eye Peter’s anomaly, right eye posterior embryotoxon and on medical therapy for glaucoma.Examination revealed significant limitation of depression and MRI orbit showed marked atrophy of right IR.On table FDT showed tight SR and free LR and MR.We planned to recess the SR with partial tendon transposition of LR and MR.On exploration all muscles were displaced from their expected insertions.SR was found 3mm lateral and 2mm posterior,MR and LR were found 3mm inferior to their original insertions.SR was recessed and attached 13mm behind the limbus. A modification of Modified Nishida was done on LR and MR because we could reach only to about 8mm behind the muscle insertion to secure it in the inferotemporal and inferonasal quadrants about 10mm behind the limbus.Post operatively the child was ortho in primary at 1month followup.