Periosteal muscle anchoring for large angle incomitant squint

Area of Science:

• Ophthalmology
• Surgical Techniques
• Strabismus Management

Background:

• Large angle exodeviations, particularly incomitant types, pose significant surgical challenges.
• Existing techniques may have limitations in achieving stable, long-term correction for these complex cases.

Purpose of the Study:

• To describe a novel periosteal anchoring surgical technique for correcting very large angle exodeviations.
• To evaluate the long-term outcomes of this evolved surgical approach.

Main Methods:

• A consecutive series of seven patients with large angle, incomitant squint underwent surgery.
• The technique involved periosteal anchoring of the medial rectus (MR) muscle insertion, with optional lateral rectus (LR) muscle manipulation.
• A retrocaruncular approach was utilized, with retrospective analysis of pre- and post-operative deviations.

Main Results:

• Seven patients with pre-operative exotropia ranging from 45 to 115 prism dioptres (PD) were treated.
• At a mean follow-up of 34 months, all patients showed reduced horizontal deviations (0-80 PD).
• Three patients required further surgery, primarily those who did not have LR muscle release initially.

Conclusions:

• Periosteal anchoring is a viable surgical option for large angle incomitant divergent squints.
• A combined bi-rectus fixation approach is advocated to maintain globe position in the primary position.