2013 Strabismus, 2013; 21(4): 225–229 ! Informa Healthcare USA, Inc. ISSN: 0927-3972 print / 1744-5132 online DOI: 10.3109/09273972.2013.833955 A conventional strabismus surgical approach for lost medial rectus muscles Halil Ibrahim Altinsoy, MD 1 , Osman Melih Ceylan, MD 1 , Fatih Mehmet Mutlu, MD 1 , and Gokcen Gokce, MD 2 1 Department of Ophthalmology, Gulhane Military Medical Academy & Medical School, Ankara, Turkey and 2 Department of Ophthalmology, Sarikamis Military Hospital, Kars, Turkey ABSTRACT We present 3 cases of successful conventional strabismus surgery to retrieve lost medial rectus (MR) muscles. In all cases the lost MR muscle was retrieved and re-attached to the intended scleral point. Two patients had residual exotropia, while the third case was orthophoric after surgery. The retrieval of lost MR muscle using conventional strabismus surgery technique can be successfully achieved if the lost MR muscle is recognized early and the re-operation is performed by an experienced surgeon. Keywords: Lost muscle, reoperation, strabismus surgery INTRODUCTION A lost rectus muscle is one that has completely detached from the globe and has retracted through the posterior Tenon’s capsule. Rectus muscles can be lost dueto trauma or surgery, including sinus surgery, strabismus surgery, and other ocular surgeries. 1-3 Medial rectus (MR) muscles lost during strabismus surgery are rarely found. 4 A lost MR muscle is usually expected in the presence of an overcorrection after esotropia (ET) surgery or undercorrection after exo- tropia (XT) surgery, resulting in limited duction in the field of action of the muscle. We present 3 cases of successful conventional strabismus surgery to retrieve lost MR muscles. MATERIALS AND METHODS Data collection and study performance conformed to the institutional ethics review board-approved protocol and were compliant with the principles of the Declaration of Helsinki. The mean age of the patients was 17.6 Æ 8.5 (21, 24, 8) years. All patients had undergone horizontal rectus muscle surgery. Preoperative and postoperative evaluation included the angle of deviation in the prism diopters (PD) as measured by the prism and cover test at near and distance, and duction limitations were graded on a scale of À1 to À4(À4, no movement beyond the midline; À3, 25% of movement remained; À2, 50% of movement remained; and À1, 75% of movement remained). 5 All of the cases were evaluated with computerized tomography (CT). Two patients under- went reoperation on the first day, and one patient 1 week after the previous strabismus surgery. Two of the patients underwent reoperation under local anes- thesia, and one (aged 8 years) had repeat surgery under general anesthesia. Using an operating micro- scope, the same surgeon (HIA) performed all of the reoperations. Case Reports Case 1 A 21-year-old man who had undergone a left lateral rectus (LR) recession of 7 mm and an MR resection of 6 mm to correct 35 PD constant XT was referred to our department. The best corrected visual acuity (BCVA) Correspondence: Osman Melih Ceylan, Gulhane Military Medical Academy & Medical School, Department of Ophthalmology, Ankara, Turkey. Tel: +903123045872. E-mail: drmelihceylan@yahoo.com.tr Received 7 November 2012; Accepted 15 June 2013; Published online 24 October 2013 225 Strabismus Downloaded from informahealthcare.com by HINARI on 01/16/14 For personal use only.