Muscle Union Procedure in Patients with Paralytic Strabismus.

To present the surgical outcomes of a muscle union procedure in patients with paralytic strabismus, this retrospective study included 27 patients with paralytic strabismus who underwent a muscle union procedure. In this procedure, the two vertical rectus muscles are united with the paralytic horizontal muscle without splitting the muscles. Postoperative ocular deviations, complications, surgical success rates, and reoperation rates were obtained by examining the medical records of the patients. Seventeen patients had a sixth cranial nerve palsy, seven patients had a third cranial nerve palsy, and three patients had a medial rectus muscle palsy after endoscopic sinus surgery. The mean preoperative angle of horizontal deviation in the primary position was 56 ± 21 prism diopters. The mean follow-up period was 12 ± 9 months. The mean final postoperative ocular deviation was 8 ± 13 prism diopters. The success rate was 74%, and the reoperation rate was 0%. No significant complications, including anterior ischemia, occurred in any of the patients. One patient exhibited an increase in intraocular pressure in the immediate postoperative period, but this resolved spontaneously within 1 week. Our muscle union procedure was effective in patients with paralytic strabismus, especially in patients with a large angle of deviation. This muscle union procedure is potentially a suitable option for muscle transposition in patients with paralytic strabismus who have large-angle deviation or a significant residual angle after conventional surgery.

Phaco windmill: nondividing, nonchopping phacoemulsification technique.

We describe a nondividing, nonchopping phacoemulsification technique for nucleus removal with minimal zonular stress. It can be applied in any type of cataract surgery, regardless of nuclear color or density, as long as the anterior chamber is stabilized and properly maintained and there is sufficient followability using torsional modality. This technique uses less phacoemulsification energy, thereby avoiding zonular stress, and does not require an initial division of the nucleus, which is another advantage for beginners. The procedure is safe and easy to learn and is most advisable for beginners as it can prevent complications.