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To compare minimally invasive strabismus surgery (MISS) with conventional strabismus surgery for horizontal recti in terms of functional outcome and complications.


A total of 40 patients requiring surgery for horizontal recti were divided into two groups: those undergoing MISS and those operated on using the conventional limbal technique. In the MISS group, two small keyhole radial cuts were made superior and inferior to the insertion of the muscle margin. Keyhole cut size was almost 1 mm less than the amount of muscle recessed or resected.


There were significant differences in conjunctival redness and swelling in both groups on postoperative days 1 and 7 and week 3. However, after the third week, both groups had a similar appearance. Visual acuity was decreased at postoperative day 1 in both groups, but the difference was not significant. No significant differences were found for final alignment, binocular single vision, other visual acuities, refractive changes, or complications.


This study shows that this new, small incision, minimal dissection technique is feasible. The MISS technique seems to be superior in the immediate postoperative period because there were fewer conjunctival and eyelid swelling complications. Long-term results did not differ between the two groups.

[J Pediatr Ophthalmol Strabismus. 2017;54(4):208–215.]

  • 1.Harms H. Über Muskelvorlagerung. Klin Monatsbl Augenheilk. 1949; 115:319–324.

    Google Scholar
  • 2.Von Noorden GK. The limbal approach to surgery of the rectus muscles. Arch Ophthalmol. 1968; 80:94–97.10.1001/archopht.1968.00980050096016

    Crossref MedlineGoogle Scholar
  • 3.Parks MM. Fornix incision for horizontal rectus muscle surgery. Am J Ophthalmol. 1968; 65:907–915.10.1016/0002-9394(68)92220-4

    Crossref MedlineGoogle Scholar
  • 4.Swan KC, Talbot T. Recession under Tenon's capsule. AMA Arch Ophthalmol. 1954; 51:32–41.10.1001/archopht.1954.00920040034005

    Crossref MedlineGoogle Scholar
  • 5.Velez G. Radial incision for surgery of the horizontal rectus muscles. J Pediatr Ophthalmol Strabismus. 1980; 17:106–107.

    LinkGoogle Scholar
  • 6.Santiago AP, Isenberg SJ, Neumann D, Spierer A. The paralimbal approach with deferred conjunctival closure for adjustable strabismus surgery. Ophthalmic Surg Lasers. 1998; 29:151–156.

    LinkGoogle Scholar
  • 7.Mojon DS. Minimally invasive strabismus surgery. In: , Fine HI, Mojon DS, eds. Minimally Invasive Ophthalmic Surgery. Springer: Heidelberg, Germany. 2009:123–152.

    Google Scholar
  • 8.Mojon DS. Comparison of a new, minimally invasive strabismus surgery technique with the usual limbal approach for rectus muscle recession and plication. Br J Ophthalmol. 2007; 91:76–82.10.1136/bjo.2006.105353

    Crossref MedlineGoogle Scholar
  • 9.Sharma R, Amitava AK, Bani SA. Minimally invasive strabismus surgery versus paralimbal approach: a randomized, parallel design study is minimally invasive strabismus surgery worth the effort?Indian J Ophthalmol. 2014; 62:508–511.10.4103/0301-4738.118448

    Crossref MedlineGoogle Scholar

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