Strabismus SurgeryAlvina Pauline D. Santiago, MD

Pediatric Ophthalmology and Strabismus

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SLMC PostGrad Course 2014

Conjunctival Opening

Fornix

Limbal

Paralimbal

Variations

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Modification: “7” paralimbal incision

1 mm paralimbal

Relaxing incision in the superotemporal or superonasal quadrant

Hidden from “oglers” because of Bell phenomenon

1 less relaxing incisionFells, P. BJO 1971 &

Santiago AP et al, Ophthalmic Surg Lasers 1998

Fig from Sami D, 2007

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Modified Paralimbal “7”-incision4

Caputo’s one snipworks best for medial rectus

Caputo AR, Guo S, DeRespinis P, et al. Simplified limbal incision for extraocular rectus muscle surgery. Ophthalmic Surg 1991; 22: 406-408.

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Fig from Sami D, 2007

Anchoring Muscle

Parks Crossed Swords

Simple Anchoring to Sclera

Hangback

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Anchoring Muscle:Parks Crossed Swords Technique

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Fig from cybersight.org

Anchoring Muscle: Resection

anchored to muscle stump

anchored to scleral insertion

muscle thinnest at insertion

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Fig from Rosenbaum & Santiago, 1999

Conjunctival Closure!

Anatomic Closure

Recess Conjunctiva

Glue (fibrin) Guo S, Wagner RS, Forbes BJ et al. Sutureless conjunctival closure. JPOS 2010: 47 (4) 228-230.

less inflammation, less discomfort

Reduced surgery time, less anaesthesia

Held well

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Fig from Rosenbaum & Santiago, 1999

ReferencesCaputo AR, Guo S, DeRespinis P, et al. Simplified limbal incision for extraocular rectus muscle surgery. Ophthalmic Surg 1991; 22: 406-408.

Guo S, Wagner RS, Forbes BJ et al. Sutureless conjunctival closure. J Pediatr Ophthalmol Strabismus 2010: 47 (4) 228-230.

Rosenbaum AL, Santiago AP. Clinical Strabismus Management, Principles and Technique. Elsevier 1999.

Sami DA. Conjunctival incisions for strabismus surgery: a comparison of techniques. Techniques in Ophthalmology 2007; 5(3): 125-129.

Santiago AP, Isenberg S, Neumann D, et al. The paralimbal approach with deferred conjunctival suture for adjustable Strabismus Surgery. Ophthalmic Surg Lasers 1998; 29: 151-156.

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Thank you!