Sliding Shape Extraocular Muscle Transposition with Plication: A Novel Method

Objectives: This study aims to present a novel operation method of delivering both vascular protection and strengthening of the muscles, as well as the transposition of the muscles.
Methods: The patients’ files were scanned retrospectively. All patients underwent a complete eye examination in addition to motility examination, both preoperatively and postoperatively. Patients were followed up at least six months. Pre- and post-operative deviation measurement values were compared statistically. Operation technique: After being exposed and the rectus muscle was freed from the facial structure as far as planned resection amount. 6-0 coated vicryl sutures were then placed through the two sides of the muscle while protecting the blood vessels. Then, each suture was placed close to the muscle insertion and was aimed at transposition side. For example, if the target was to transpose the superior rectus at the temporal side, nasal side suture was placed at temporal edge of muscle insertion, and temporal side suture is placed approximately a tendon width laterally to the insertion.
Results: In patients who were planned resection 7 mm and over, the procedure for complete muscle widening transposition was successful. Only 2/3 transpositions could be achieved in four patients who underwent less than 7 mm of strengthening. There was no anterior segment ischemia in three patients who underwent three rectus muscle surgery in the same eye.
Conclusion: ‘Sliding shape’ design extraocular muscle plication found a simple, safe and effective procedure for patients who needed resection and transposition operation. More patients and longer follow-up are needed to understand the real effectiveness.