Minimally invasive strabismus surgery for rectus muscle posterior fixation

AIMS: To present a novel, minimally invasive strabismus surgery (MISS) technique for rectus muscle posterior fixation. METHODS: This study reports the results of 32 consecutive MISS rectus muscle posterior fixation surgeries performed on 19 patients by applying only two small L-shaped openings where the two retroequatorial scleromuscular sutures were placed. RESULTS: On the first postoperative day, in primary position, redness was hardly visible in 16 eyes (50%) and only moderate redness was visible in 6 eyes (19%). No serious complication occurred. Preoperative visual acuity and refraction remained unchanged at 6 months (p > 0.1). The preoperative convergence excess (n = 13) decreased from 10.3 +/- 4.1 to 5.2 +/- 4.0 degrees at 6 months (p < 0.005). In all patients operated on for gaze incomitance (n = 6) improvement was achieved at 6 months. CONCLUSIONS: This study shows that keyhole minimal-dissection rectus muscle posterior fixation surgery is feasible and effective to improve ocular alignment. The MISS technique seems to be superior in the direct postoperative period since only minimal conjunctival swelling and no corneal complications were observed