Modifications of and special operating tricks in the classical technique of surgery against strabismus

Even nowadays the idea of most of the operations against strabismus is based on myectomy and reposition of the rectus muscles. At the Department of Ophthalmology of the University Medical School of Debrecen we use mainly these two methods of operation. At our Department we performed 1605 operations against strabismus during the last 10 years. 1269 of our patients had convergent, 336 had divergent strabismus. The majority of the operations were performed on patients less than 6 years of age, under general anesthesia. The outcome of the operation is successful if it results in a situation, in which torque affecting the eyeball stabilizes it in the normal position. The advantage of the combined surgical procedure is that the former muscular balance remains intact, and by relatively small intervention good results can be achieved. In the rectus muscles of squint patients anatomical and histopathological changes could be found, especially if they did not receive pleoptic treatment preoperatively. Depending on the direction of the strabismus one of the muscles is thicker, while the other is thinner, due to hyper- and hypofunction. Our surgical experience of many years showed that by modifying the classical technique of the operations with some fine technical tricks it was possible to increase the success rate. In our film we presented the right way of incising and handling the subconjunctival connective tissue (Tenon capsule) thus making it possible to lay it back to its original place at the end of the operation. This way the chance of postoperative scarring is reduced. We demonstrated how to test the contractility of the muscles by using muscle-hooks, that replaces the forceps test. In case of myectomy we demonstrated the tricks of how to handle the easiest and the finest way. In case of retroposition we can achieve perfect reconstruction and wound healing by using the shown simple technique. We also take much care of suturing the conjunctiva during operations performed on infants that is important because of their undisciplined behavior.