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Muscle Bound

Complex strabismus procedure offers faster recovery

Surgery to correct the eye misalignment characteristic of strabismus can require operations on several muscles, causing lengthy recovery. In addition, the correction sometimes overcompensates for the problem, requiring repeat operations. A single simplified procedure adopted at Children’s Hospital Boston has shown good results, researchers report, and allows for eye position to be fine-tuned in the recovery room or up to a week later, often avoiding follow-up surgery.

In the February issue of Archives of Ophthalmology, a team led by David Hunter, an HMS professor of ophthalmology and chief of ophthalmology at Children’s Hospital Boston, reports on results of a procedure known as superior rectus transposition with adjustable medial rectus recession in 17 patients who could not move an eye outward. The new procedure enabled outward eye movement by repositioning a muscle that normally moves the eye up.

Unlike earlier procedures, the new one adjusts a single muscle, the superior rectus, to rotate the eye into place. In some cases, the medial rectus muscle is also adjusted, but the inferior rectus, often the source of complications, is untouched. The technique also uses an adjustable sliding “noose” knot to pull the eye muscles. The knot can be tightened or loosened afterward to adjust the eye’s position in the recovery room or up to a week after surgery.

“Because we cannot always guarantee optimal alignment after surgery,” says coauthor Linda Dagi ’82, an HMS assistant professor of ophthalmology and director of Children’s program for adults with strabismus, “we found the adjustable suture technique to be the best option for patients.”

In their study, the team reviewed long-term outcomes and found improvements in horizontal eye movement and outward movement, with minimal cost to inward movement. Eight of the patients regained depth perception. No patient developed a significant problem with vertical eye alignment, a potential risk of the procedure.

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