Jensen Procedure Research Articles

Hemi-Jensen Procedure as Heavy Eye Syndrome Treatment: A Case Series

Introduction : Heavy eye syndrome is an acquired myopia-associated strabismus characterized by esotropia and hypotropia accompanied by abduction and elevation limitations. This case series reports two heavy eye syndrome patients that underwent hemi-Jensen procedure combined with medial rectus recession with good postoperative result.
 Case Illustration : A 60-year-old female had right eye (RE) fixed inward and bilateral high myopia (S-13.00 D). RE Hirschberg test: >45° esotropia and hypotropia and RE axial length (AL) 28.3 mm. Second patient, a 53-year-old female, had both eyes fixed inward and bilateral high myopia (S-12.00 D). Both eyes Hirschberg test: >45° esotropia and hypotropia, left eye AL 31.4 mm, and prephthisis RE. Intraoperative identification of both patients revealed displacement of superior and lateral rectus muscles. No surgery performed on prephthisis eye. Hemi-Jensen procedure combined with medial rectus recession resulted in orthophoria (first patient) and central position in primary gaze (second patient), with improved ocular motility on both patients.
 Discussion : Heavy eye syndrome occurs in eyes with high myopia. The elongated globe in high myopia results in superotemporal herniation of the globe and superior and lateral rectus muscles displacement, which increases depression and adduction force. Hemi-Jensen procedure is a loop myopexy procedure which corrects the deviated muscle paths in heavy eye syndrome. Concurrent medial rectus recession can be performed with hemi-Jensen procedure if there is likely contracture of medial rectus.
 Conclusion : Heavy eye syndrome is a strabismus fixus condition which occurs in eyes with high myopia. Hemi- Jensen procedure is an effective treatment for heavy eye syndrome which improves ocular alignment and motility.

Outcome of Jensen Procedure for Complete Abducent Nerve Palsy in Tertiary Eye Hospital of Nepal

Introduction: Jensen procedure is done for correcting large amount of esotropia and improving abduction in complete abducent nerve palsy. It is a modified form of transposition surgery where the superior, inferior, lateral rectus muscles are split longitudinally and their lateral halves are respectively joined to the superior halves and inferior halves of lateral rectus with non-absorbable sutures. The study was done to find the surgery outcome of Jensen Procedure in complete abducent nerve palsy. Methods and Materials: A retrospective study of complete abducent nerve palsy of greater than six months duration that underwent Jensen Procedure was performed. Preoperative deviation and postoperative deviation at six weeks and three months were measured and analyzed. Clinical photography and diplopia charting of each case was done before surgery, and postoperatively at three months follow up in all cardinal gazes. Results: Eight eyes of eight patients with the mean age 38.50 ± 22.32 years (16 - 83) underwent medial rectus recession with muscle union (Jensen’s) procedure. Three right eyes and five left eyes were operated. The preoperative esodeviation reduced from mean preoperative 74.37±28.21∆ (30 - 120∆) base out to mean post-operative 12±12.29∆ (-8 – 30∆) base out. The abduction deficit improved from mean preoperative -3.75 ± 0.46 (-4 to -3) to postoperative -1.87 ± 0.99 (-3 to 0). All cases were satisfied with their ocular alignment and cosmesis. Conclusion: The Jensen Procedure can successfully correct the large amount of deviation due to complete abducent nerve palsy with improvement in functionality, abduction deficit and cosmesis.

Overcorrection after vertical muscle transposition with augmentation sutures in sixth nerve palsy.

To report a series of cases, who developed consecutive exodeviation after vertical muscle transposition (VRT) performed for sixth nerve palsy, describe their management and analyse their outcome. Retrospective case series. This is an institutional study on patients who developed consecutive exotropia following VRT for sixth nerve palsy in two different centres. The age, gender, cause, and time to surgery were reviewed. Ductions, versions and angles of misalignment were analysed. In those who developed an exotropia >10 PD after surgery, a second surgery was performed. The time to the second surgery, intra-operative findings, surgical procedure and outcome were studied. A total of 164 cases of VRT for sixth nerve palsy were identified. Nine patients developed consecutive exotropia >10 PD (5.5%). There were no significant differences in the characteristics of those who developed overcorrection compared to those who did not. Five patients had full-tendon muscle transposition, three patients had Hummelsheim procedure and one patient had Jensen procedure. The average angle of consecutive exotropia was 26 ± 9 Δ (range 10-40 Δ). After the second surgery, angle of exotropia decreased to 21 ± 15 PD. Seven patients still had residual exotropia ≥10Δ and the exotropia was corrected in the remaining two patients. The time to second surgery in those two patients was much shorter than the other seven patients. Patients who undergo VRT should be followed up in the early post-operative period and revisiting the transposition should be done immediately in case of consecutive exotropia to avoid permanent overcorrection.

Comparison between Hummelsheim and Jensen procedures in the management of chronic sixth nerve palsy

To compare the postoperative alignment, degree of improvement of abduction, and complications of the Hummelsheim procedure to the Jensen procedure in chronic sixth nerve palsy, and to calculate the dose-response of both procedures. A retrospective study was done on patients who either had Hummelsheim or Jensen procedure for chronic sixth nerve palsy. Demographic characteristics, details of surgical procedure, ductions, versions, and angles of misalignment before and after surgery were analyzed. A total of 79 patients were identified: 38 Jensen and 41 Hummelsheim. There were no statistically significant differences in baseline characteristics of both groups. Medial rectus recession was performed in 35 patients in the Jensen group and in 30 patients in the Hummelsheim group. Success defined as orthotropia within 8 PD was achieved in 25 (66%) patients in the Jensen group and in 24 (59%) patients in the Hummelsheim group (P = 0.51). The mean improvement in the angle of deviation in the primary position was 42 ± 12 PD in the Jensen group and 42 ± 16 PD in the Hummelsheim group (P = 0.89). The mean improvement in abduction was slightly better in the Hummelsheim group (1.8 vs 1.5, P = 0.32). A new vertical deviation occurred in three patients in the Jensen group and in 4 patients in the Hummelsheim group. Anterior segment ischemia occurred in one patient in the Jensen group. There was no difference in the success rate between the Hummelsheim and Jensen procedures in cases of chronic sixth nerve palsy. Strabismus surgeons can choose between the two procedures according to their preference.

Jensen's procedure combined with adjustable medial rectus recession to treat complete sixth nerve palsy

Patients with complete sixth nerve palsy have severe limitation of abduction, often leading to primary position esotropia that is associated with a compensatory head posture, reduced stereopsis, and diplopia. The purpose of this study is to present and eveluate the results of Jensen's procedure and medial rectus recession with adjustable suture to correct the esotropia in cases of complete sixth nerve palsy.

Comparison of the efficiency of various muscle transposition procedures using a novel three-dimensional model.

AimTo investigate the performance of a newly developed three-dimensional (3D) biomechanical model in various transposition procedures for correction of complete sixth nerve palsy with educational purpose.MethodsA 3D biomechanical eye model was created using Hyperworks software based on geometry data and the biochemical properties of the eyeball and extraocular muscles. A complete sixth nerve palsy model was achieved via modification of lateral rectus muscle strength. Four different muscle transposition procedures (the Hummelsheim, Jensen, Foster, and muscle union procedures) were set up, and the objective surgical effect of each procedure was calculated using 3D model simulation.ResultsIn the 3D simulation, sixth nerve palsy was modeled by rotating the eye 34.16 degrees in the medial direction, consistent with 70 prism diopter (PD) esotropia. In surgical model simulation, the Hummelsheim procedure resulted in a 28 PD reduction of total deviation, the Jensen procedure achieved a 34 PD reduction, the Foster procedure led to a 57 PD reduction, the muscle union procedure yielded a 57 PD reduction in esotropia in sixth nerve palsy.ConclusionThe 3D simulation provided a consistent model of sixth nerve palsy and objective data excluding the potential for variation of surgical skill. It could also help predict surgical outcomes.

Clinical Research on the Efficacy of Modified Surgery for Esotropia Fixus With High Myopia.

To investigate the efficacy of a modified surgical procedure for esotropia fixus with high myopia. Thirteen patients (15 eyes) with esotropia fixus and high myopia who underwent the Jensen procedure for superior and lateral rectus muscles at Southwest Hospital between February 2014 and December 2015 were retrospectively analyzed. Intraoperatively, the superior rectus and lateral rectus muscles were separated up to 12 to 14 mm posterior to their respective insertion. A medial rectus large recession or rectus tenotomy was performed based on the degree of fibrosis of the medial rectus muscle. Postoperative examinations were performed at 1 day, 2 weeks, 3 months, and 6 months. On the first postoperative day, 12 eyes (10 patients) were in the primary position (80.0%), 2 eyes (2 patients) exhibited 5° to 10° esotropia (13.3%), and 1 eye (1 patient) exhibited 15° esotropia (6.7%). At the 2-week follow up, 1 eye (1 patient) was lost to follow-up, 9 eyes (7 patients) were in the primary position (64.3%), 3 eyes (3 patients) exhibited 10° esotropia (21.4%), and 2 eyes (2 patients) exhibited 15° to 20° esotropia (14.3%). At the 3-month follow-up, the patient whose ocular alignment was 20° esotropia at 2 weeks was found to have developed 30° esotropia; no change was observed in the other patients. A remarkable improvement in ocular motility was observed in all patients. The Jensen procedure for the union of the superior rectus and lateral rectus muscles, using two pairs of sutures applied 12 to 14 mm posterior to their respective insertions, yielded favorable outcomes. [J Pediatr Ophthalmol Strabismus. 2018;55(4):219-224.].

Rectus muscle transplantation combined with Jensen procedure for the correction of special strabismus

Objective To evaluate the efficacy of the combined surgery of rectus muscle transplantation and Jensen procedure in the correction of special types of paralytic strabismus. Methods Partial transplantation of the superior and inferior rectus were performed on the horizontal strabismus, while partial transplantation of the medial and lateral rectus were performed on the vertical strabismus. There were two stages in the combined surgery. On the first stage, recession operation of the antagonist muscles associated to the paralyzed or dysplastic muscle was performed. On the second stage, Jensen procedure was performed by combining the transplanted muscle and the paralyzed or dysplastic rectus on the basis of partial rectus transplantation. Results The postoperative eye position was finely corrected and the ocular movement was significantly improved. Besides, part of visual functions were improved, and the complication of anterior segment ischemia wasn't been observed. Conclusion This combined operation not only corrects the eye position of large angle strabismus, but also improves the ocular movement, as well as the binocular visual functions. Key words: Strabismus, paralytic, special type; Rectus muscle transplantation, partial; Jensen procedure; Combined surgery

A Case of Nishida Muscle Transposition Procedure for Abducens Palsy

Purpose: Herein we report a successful Nishida muscle transposition procedure (modified Jensen procedure) with right medial rectus recession for treating a right abducens palsy patient. Case summary: A 63-year-old male presented with a 30-year history of esotropia due to traumatic abducens palsy in his right eye. At initial examination, right eye visual acuity was 0.9 and intraocular pressure was 11 mm Hg. Ocular movement of the right eye was restricted in the lateral direction and prism cover-uncover test revealed 75 prism diopter right esotropia. For 2 years, the patient was treated as normal tension glaucoma and used his right eye as the dominant eye by turning his head due to glaucomatous field defect in the left eye. We performed 8.0 mm medial rectus recession and Nishida muscle transposition procedure in the right eye and inserted a suture through the temporal margin of each vertical rectus muscle. One week after surgery, the right eye maintained relatively straight alignment and prism cover-uncover test showed 20 prism diopter residual esotropia in the left eye. Conclusions: The Nishida muscle transposition is a simple procedure and prevents postoperative risk of anterior segment ischemia without the occurrence of tenotomy and muscle splitting. We report a successful Nishida muscle transposition procedure in a patient with chronic abducens palsy. J Korean Ophthalmol Soc 2015;56(8):1294-1299

The Efficacy of Vertical Rectus Transposition and Its Modalities in Patients with Abducens Nerve Palsy

Patients with VIth nerve palsy that does not resolve within 6 months should undergo surgery. The most common procedure used in such cases is transposition of a whole or a part of a vertical rectus muscle combined or not with a resection of the lateral rectus muscle. Commonly, a simultaneous recession of medial rectus muscle with or without prior injection of botulinum toxin is performed. The aim of our study was to evaluate the results of vertical rectus transposition performed in patients with abducens nerve palsy. Nine cases of abducens nerve palsy ware retrospectively analyzed. All patients underwent full ophthalmic and orthoptic examination before and after surgery. All patients underwent vertical rectus muscle transposition to the lateral rectus insertion in the affected eye. Additional procedures included Jensen procedure, botulinum toxin injection, resection of the lateral rectus, recession of the medial rectus on the same side with or without adjustable sutures, and Foster modification of lateral rectus posterior fixation. In all cases, we found a varying degree of postoperative improvement. There was a significant reduction in the strabismus angle for distance and near, increase in abduction of the affected eye, and broadening of the field of binocular single vision. The vertical rectus muscle transposition technique is a safe and successful method of treatment in abducens nerve palsy. Its use together with additional procedures and modifications allows one to achieve orthophoria, improvement of abduction, and larger field of binocular single vision.

Anterior dislocation of a sulcus fixated posterior chamber intraocular lens in a high myope

A 31-year-old man with high axial myopia and strabismus fixus convergens underwent bilateral refractive lens exchange followed by a squint surgery (bilateral superior partial Jensen's procedure and medial rectus recession). After one year he presented with traumatic anterior dislocation of the sulcus fixated posterior chamber polymethyl methacrylate lens. The lens was dialed back into the ciliary sulcus without any complications. This case highlights the importance of implanting an intraocular lens (IOL) in-the-bag. If the IOL needs to be implanted in the sulcus, a larger diameter of the IOL with larger optic size and overall length is desirable, especially in highly myopic eyes.

Partial Jensen's procedure for the treatment of myopic strabismus fixus

Myopic strabismus fixus (MSF) is a rare strabismus entity of uncertain etiology. The most recent explanation of etiology was provided by Yokoyama et al,(1) who noted that the enlarged globe in high myopia herniates superotemporally and retroequatorially through the muscle cone. In a typical case, the eye is fixed in depression and adduction. We report the use of a partial Jensen's procedure (superior arm only) for the treatment of MSF.

A Muscle Transposition Procedure for Abducens Palsy, in Which the Halves of the Vertical Rectus Muscle Bellies Are Sutured Onto the Sclera

Purpose: To review the results of a muscle transposition procedure in which the halves of the vertical rectus muscle bellies are sutured onto the sclera, without tenotomy of vertical recti as in Hummelsheim's procedure or surgical treatment of the lateral rectus (LR) as in Jensen's procedure. Methods: Ten patients with abducens palsy received the procedure. We measured the ocular deviation and the field of single binocular vision, and observed the LR using magnetic resonance imaging (MRI). Results: Preoperative or postoperative deviation was distributed from +27 to +58 prism diopters (PD) or orthophoria to +12 PD, respectively, in 7 patients with unilateral paresis, and +75 to +120 PD or +2 to +37 PD in 3 patients with bilateral paresis. The average correction was 42.4 PD per eye. Seven patients were able to regain the field of single binocular vision at least in the primary position. No postoperative complications were observed. MRI showed that the LR was atrophic and floppy, lacking muscle tension. Conclusions: Our procedure enabled the patients to obtain satisfactory postoperative results without treatment of the LR or tenotomy of the transposed muscles. This procedure can reduce operative damage to the eye more than Hummelsheim's or Jensen's procedure.

Reaction time measures of speed of processing: Speed of response selection increases with age but speed of stimulus categorization does not

We report an experiment that investigates the relationship between speed of information processing and development. The goal of the experiment was to compare developmental changes at two stages of processing—response selection and stimulus categorization. The experiment compared developmental change on three kinds of reaction time task. The first was a standard Jensen (1982) procedure which separates the decision and motor components of reaction time, the second was a modification of this procedure suggested by Smith & Carew (1987) to control for possible anticipatory strategies, and the third was a more traditional reaction time task where each stimulus is paired with a unique response (lights‐to‐keys). Age changes in speed of information processing were found for the lights‐to‐keys task but not for either of the Jensen tasks. We argue that this is because the lights‐to‐keys task taps response selection factors that change with age and that are orthogonal to differences in speed of stimulus categorization indexed by the standard Jensen task. If the latter is taken as the purer index of speed of processing then we conclude that speed of processing does not change with age.

Anterior Segment Ischemia After the Jensen Procedure in a 10-Year-Old Patient

We recently encountered anterior segment ischemia in a young healthy girl with traumatic abducens nerve palsy after the Jensen procedure and ipsilateral recession of the medial rectus muscle. The patient was treated with topical dexamethasone and homatropine 2% and oral prednisone. The patient's condition improved, and six weeks postoperatively, visual acuity was 20/20. As this complication of anterior segment ischemia is potentially serious and unpredictable, we think that an alternative surgical approach should be used when treating patients with muscle palsies.

On a Proposal of Jensen for the Analysis of Ordinal Pairwise Preferences Using Saaty's Eigenvector Scaling Method

In 1977, Saaty proposed a scaling method for priorities based on the normalized, positive eigenvector corresponding to the largest eigenvalue of a matrix of paired comparisons. Originally designed for analyzing preferences expressed on a ratio scale, this technique was adapted by Jensen to handle ordinal,-"pick-the-winner" type, dominance data. It involves a coding parameter, a > 1, whose interpretation is akin to the sociometric concept of attenuation of influence transmitted through intermediaries developed by Katz. This paper examines the implications of Jensen's proposal and illustrates the effect of the constant a as a comparison reliability factor on the ordinal ranking of alternatives. Jensen's procedure is seen to provide a continuum of orderings between the Kendall scores, or total vote count ranking, and Wei's solution to the tournament ranking problem described by Kendall. In this context, circumstances are also delineated where Saaty's eigenvalue-based index of cardinal consistency is functionally related to a classical measure of ordinal consistency involving the number of circular triads in a respondent's judgments. Beyond its intrinsic theoretical interest and practical value, it is argued that the methodology put forward by Jensen is a useful diagnostic tool for analyzing the ordinal structure of pairwise comparisons and for spotting potentially contentious applications of Saaty's scaling procedure.

Congenital Absence of the Superior Rectus Muscle: A Case Report

We report a case of bilaterally absent superior rectus muscles presenting clinically as a double elevator palsy. This patient is unique due to paradoxical ocular movements on attempted upgaze and the absence of other major craniofacial anomalies. Successful surgical correction was accomplished using a modified Jensen procedure where the superior halves of the horizontal rectus muscles were united using synthetic absorbable sutures. Congenital absence of the superior rectus muscles should be suspected in patients with severe elevation deficiency associated with paradoxical ocular movements.

Surgical Treatment of Lateral Rectus Muscle Paralysis

We conducted a retrospective study of 55 cases to investigate the effectiveness of three different surgical procedures (medial rectus muscle recession and lateral rectus muscle resection in 16 cases, the Hummelsheim procedure in 27 cases, and the Jensen procedure in 12 cases) in the treatment of lateral rectus muscle paralysis. All three procedures were equally effective. Shorter duration of lateral rectus muscle paralysis, greater preoperative lateral version, less contracture of the medial rectus muscle, and a traumatic origin for the sixth cranial nerve damage had a significant effect (P less than .05) on the final results of surgery.

Jensen's reaction-time investigations of intelligence: A critique

Jensen has reported a series of reaction-time studies which lead him to conclude that various parameters correlate significantly with IQ. Certain of these parameters are especially emphasized because of their theoretical background and the resulting theoretical light they shed upon the nature of intelligence. Two of the lime-lighted parameters are slope of RT across set size and increasing correlations of RT with IQ as set size increases. I review these studies in detail. I conclude that Jensen's claims are unwarranted. There are many difficulties in his approach that cover the entire gamut from method to data to theory. Some original reseach of my own is reported to illustrate the methodological problems with Jensen's procedure. The data that he alludes to often do not support his claims. The theory that he applies does not fit his paradigm. My conclusion: such research is not easy.

Evaluation of Jensen procedures by saccades and diplopic fields.

A total of 15 eyes of 13 patients with lateral rectus palsies underwent Jensen procedures; one eye had a medial rectus recession and lateral rectus resection. It was arbitrarily decided to perform a Jensen procedure for patients with less than 40% normal abduction saccadic function. The patients' conditions were evaluated preoperatively and postoperatively by prism cover test. Versions, forced ductions, saccadic velocities, and diplopic field examinations were done. Postoperatively, all patients showed improved saccadic function; 12 of 13 patients acquired a functional range of diplopia-free vision; and 11 of 13 patients had aligned eyes with a good head position. By retrospective analysis we determined that the Jensen procedure gives good results for patients with severe lateral rectus palsy (less than 40% normal saccadic function).