A new modfied anchored suspension-recession (so-called "hang-back" technique for high risk strabismus surgery.

PURPOSE: To intruduce a new method for rectus muscle recession in order to minimize the riSk of a lost or slipped muscle and scleral perforation and compare it with the conventional method. PATIENTS AND METHODS: In a prospective study between May 2002 and December 2006, 69 patients underwent recession with the modified technique, and 50 patients underwent recession with the conventional method. We compared the results of strabismus surgery in these non-randomized series with esotropia or exotropia treated with conventional surgery with the modified technique surgery. Patients in the modified technique group were high risk patients that had large angle recession, thin sclera or less exposure sugical field. RESULTS: Surgical outcomes were not significantly different in the two treatment groups that based on their findings had been classified into four subgroups. No complications such as globe penetration, muscle slippage or lost muscle were observed during the follow up period of 12 months. CONCLUSIONS: It seems that the modified method introduced in this study can reduce the complications and risks involved in conventional and suspension-recession methods and it is safe and effective for muscle recession. It can decrease the risk of globe perforation since the sclera behind the insertion is penetrated only superficially because of anchor suturing to the muscle insertion stump, and the possibility of lost or slipped recessed muscles would be minimized.

Intraoperative adjustable suture surgery for excyclotorsion: a modification of the harada-ito procedure.

This study evaluated the surgical results of intraoperative adjustable tucking of the anterior portion of the superior oblique tendon for treatment of excyclotorsion. Two cases of acquired bilateral superior oblique palsy with symptomatic excyclotorsion and minimal vertical deviation in primary position were considered. Tucking of the anterior one-third of the superior oblique tendon was performed with a nonabsorbable suture. The amount of tuck was adjusted until the fovea was at the level of the superior one-third of the disc through indirect ophthalmoscopy. In the patient with local anesthesia, a double Maddox rod test was used to evaluate subjective cyclotorsion intraoperatively. After surgery, the patients became symptom-free. No regression toward excyclotorsion was noted during 18 months of follow-up. Tucking of the anterior portion of the superior oblique tendon is an effective procedure for improving symptomatic excyclotorsion in patients with bilateral superior oblique palsy without significant vertical deviation in primary position.

Muscle belly union for treatment of myopic strabismus fixus.

PURPOSE: To evaluate the surgical results of the medial rectus (MR) muscle recession associated with longitudinal splitting of the lateral rectus (LR) and superior rectus (SR) muscles and surgical union of their corresponding midpoints in highly myopic patients with severe esotropia and hypotropia and restricted abduction and elevation. METHODS: Six cases of severe high myopic strabismus fixus were considered with more than 90Delta esotropia and 25Delta to 30Delta hypotropia. The nasally deviated SR muscle and inferiorly shifted LR muscle were confirmed by MRI or CT scan. Supratemporal herniation of the globe from the muscle cone was also found by imaging. The LR and SR muscles were split in half from the insertion to past the equator. The lateral half of the SR muscle was united to the superior half of the LR muscle. Medial rectus muscle was recessed also. RESULTS: Motility gradually improved and by 8 weeks in four cases there was 5Delta to 15Delta residual esotropia and no hypotropia and mild limitation in abduction and elevation. In two cases due to marked residual esotropia, we performed a second operation, and 2 months later residual esotropia was mild. CONCLUSION: In highly myopic patients, if the deviant paths of the LR and SR muscles are demonstrated by MRI or CT scan, the surgical method described is effective and recommended.