Polytetrafluoroethylene in the surgery of cases with severe limitation of abduction - Long-term results

Background: In cases of severe palsy or paralysis of eye muscles, it is som etimes necessary to extensively weaken the homolateral antagonist. Large re cessions reduce the ocular motility by shortening the arc of contact betwee n muscle and sclera. The lengthening of the muscle tendon with Fascia lata, Lyo-Dura(R), or the free transplantation of an excided piece of autologous eye muscle tendon does not ensure predictable precise results. We used pol ytetrafluoroethylene (PTFE, Gore-Tex(R)) for seven years and report on our results. Method: A new technique is introduced in which the muscle is lengt hened by PTFE. Ten patients (7 sixth nerve palsies, 1 strabismus fixus, 2 D uane's retraction syndromes) underwent lengthening of the medial rectus mus cle with a Gore-Tex(R) soft tissue patch between 8 and 14 mm in size. The t wo patients with the Duane's retraction syndrome were not operated on the r ectus externus muscle. All other patients had a resection of the paralytic muscle. Results: In most cases, good results were obtained: binocular singl e vision in primary head position within a small field of fusion. Histologi cal examination of a specimen of Gore-Tex(R) four years after surgery showe d an excellent integration of the graft into the tissue. Fibrous connective tissue wrapped the Gore-Tex(R) like a capsule. There were no signs of infl ammation or graft reaction. Conclusions: PTFE (Gore-Tex(R) Soft Tissue Patc h) is a suitable material for complicated strabismus surgery. Main advantag es: availability at any time in the operation theater; high biocompatibilit y; form stability; and no diminution of operative results.