SURGICAL TECHNIQUES OF STRABISMUS

Improvements in the management of strabismus are largely dependent on making the specific diagnosis and differentiating patterns of strabism us. This finding is especially true in the management of superior obli que paresis because there are various types. Recent observation sugges ts that superior oblique paresis may be associated with a lax superior oblique tendon and that the cause of the paresis is not always neurog enic. Some authorities have suggested using the traction test of the s uperior oblique to determine whether the superior oblique tendon is la x. If it is lax, the treatment of choice would be a tightening procedu re of the superior oblique such as the superior oblique tuck. Adjustab le-suture strabismus surgery has reduced the incidence of repeat opera tions; however, adapting the procedure to the fornix incision has been difficult. The use of a scleral traction suture that retracts the con junctiva to expose the muscle suture area has been useful for fornix s urgery. The rectus muscles supply circulation to the anterior segment via the anterior ciliary vessels, which are routinely interrupted duri ng strabismus surgery. Various procedures have recently been described to preserve the anterior ciliary vessels, and these procedures will b e useful in patients who are predisposed to anterior segment ischemia. In the 1950s, inferior oblique weakening procedures were deemed dange rous and unpredictable. Recent advances in the understanding of inferi or oblique physiology and fascial relationships have inspired the deve lopment of a new inferior oblique weakening strategy-the anteriorizati on procedure. By moving the inferior oblique insertion from posterior to the equator or anterior, the inferior oblique muscle function chang es from an elevator to neutral-vertical mover or a depressor. These re cent contributions have advanced the surgical treatment of difficult a nd complicated strabismus.