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The authors propose the technique of transplantation of the resected muscle segment to the previously recessed muscle for correction of residual / recurrent strabismus in order to restrict surgery to one eye and avoid large recession of previously recessed rectus muscles. They describe the feasibility and early outcomes of this technique in seven patients with resection / recession for horizontal strabismus. This was a retrospective review of six patients with medial rectus resection / re-resection and transplantation of the resected segment to the lateral rectus for exotropia; and one patient with lateral rectus resection and transplantation of the resected segment to the medial rectus for esotropia. All achieved good alignment (postoperative angle mean of <12PD) in primary gaze at six-week follow-up. There were no cases of postoperative diplopia. Median improvement in primary gaze angle was 32PD (23-48) at six weeks and 30PD (15-40) at last follow-up. There were no intra or postoperative complications other than slight prolonged congestion in the operated eye. Postoperative limited duction was noted in five patients; typically -1 limitation. There was no significant change in palpebral fissure height or globe retraction. The authors discuss potential advantages of this technique which are mainly avoidance of operating on the fellow eye and consequences of large resections. They urge caution as the study had a small sample size and operations were on previously operated muscles. They propose this technique may be useful when reoperation must be limited to one eye and recommend further study with larger numbers, wide range of angles and longer follow-up.

Horizontal rectus muscle transplantation for recurrent and residual strabismus.
Kannam M, Sutraye J, Kapoor R, et al.
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Fiona Rowe (Prof)

Institute of Population Health, University of Liverpool, UK.

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