Tendon Elongation with Fascia Lata Grafts in Strabismus Surgery - Multiple Indications Apart from Graves' Orbitopathy

To investigate the use of fascia lata (FL) grafts for eye muscle tendon elongation in patients with complex and residual strabismus types apart from Graves' orbitopathy.

In this retrospective study, a heterogeneous group of 27 eyes of 21 patients with complex and residual strabismus types who underwent elongation of the eye muscle tendon with FL were included. Orthoptic and ophthalmological examinations including measurement of the head posture, the extent of deviation in primary position (PP), and monocular excursion were conducted preoperatively and after a mean postoperative time of 12.2 (6.0 - 37.0, median 7.0) months in all patients.

Eight patients (12 eyes) with residual exotropia, 4 patients (4 eyes) with residual esotropia, 4 patients (6 eyes) with partial abducens nerve palsy, 4 patients (4 eyes) with vertical deviation, and 1 patient (1 eye) with Duane's retraction syndrome (DRS) type I were included. A residual squint angle of 10Δ or less was achieved in 57.1% of the patients at the last follow-up. The head posture was significantly reduced at the last follow-up compared to preoperatively in patients with residual exotropia (p = 0.002), esotropia (p = 0.040), abducens nerve palsy (p = 0.005), and vertical deviation (p = 0.005). At the last follow-up, a significant reduction in the squint angle occurred in patients with residual exotropia (p = 0.001), abducens nerve palsy (p = 0.046), and vertical deviation (p = 0.033).

FL grafts may offer safe and effective surgical options for complex and residual strabismus types. No significant reduction in the excursion into the fields of action of the affected muscles was witnessed.