Large-angle strabismus and primary true muscle transplantation

Large-angle strabismus often demands a series of surgeries to achieve satisfactory alignment. This often necessitates bilateral surgery, which patients may be reluctant to undergo.

Three patients with large-angle esotropia, not amenable to standard recession and resection procedures, underwent primary true muscle transplantation wherein a fragment of resected extraocular muscle was used to elongate the medial rectus muscle.

Postoperative deviation was within +/- 10 PD of orthophoria and was maintained at follow-up of 6 to 12 months. There was mild underaction of the weakened muscle.

True muscle transplantation is a good option because it permits correction of large-angle strabismus with two-muscle surgery, provides a satisfactory cosmetic alignment, and appears safe and predictable.