Surgery Figure 3: Advanced Minimally Invasive Strabismus Surgery Techniques
Minimally invasive strabismus surgery (MISS) rectus muscle retroequatorial myopexia (A);13 MISS partial rectus muscle transposition (B);14 MISS rectus muscle repeat surgery, here a muscle advancement (C);15 MISS graded inferior oblique recession (D).16
transpositions are possible, simultaneous bilateral transpositions can also be performed.
Minimally Invasive Strabismus Surgery for Rectus Muscle Repeat Surgery
The principle of MISS surgery can also be applied to repeat rectus muscle surgery. Knowledge of what surgery has been done previously will allow minimising of the MISS keyhole openings by placing them exactly where the muscle insertions lie. Alternatively, the insertion can be determined pre-operatively, using the slit-lamp, or intra-operatively, by observation of the movement of the vessels while the eye moves. Conjunctival vessels will freely rotate, while the vessel at the insertion will not. The big advantage of a MISS approach is that the surgeon will not have to reopen an already traumatised perilimbal conjunctiva
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and thus, avoids the risk of a permanent increase of conjunctival redness and scarring and probably also decreases the risk of anterior segment ischaemia.9
The principals of surgery are similar to primary MISS rectus recessions and plications. Previously recessed muscles should be advanced and not plicated15
(see Figure 3C).
Minimally Invasive Strabismus Surgery for Inferior Oblique Recession
MISS inferior and superior oblique recessions of more than 6mm are performed using two keyhole openings. Through the first one, the disinsertion is performed and a second one is used for scleral anchoring. In order to safely pass the needle between the two cuts, a
EUROPEAN OPHTHALMIC REVIEW
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