A New Transconjunctival Muscle Reinsertion Technique for Minimally Invasive Strabismus Surgery

Purpose: To describe a novel, minimally invasive strabismus surgery (MISS) technique for horizontal rectus muscle recessions, plications, and advancements. Methods: Subjects for this prospective study were the first 20 consecutive patients who underwent unilateral horizontal rectus muscle surgery with a transconjunctival suturing (TRASU) technique for primary muscle displacements of 4.5 mm or greater or for repeat muscle displacements of 3.0 mm or greater. Results: The TRASU technique was associated with no increase in complication rate and was accomplished through a conjunctival approach with an incision that was smaller by 31% +/- 11% compared to incisions for previously described MISS approaches. Of the 19 patients (20 eyes) returning for follow-up, 11 (55%) had minimal redness as the only grossly visible sign of surgery on the first postoperative day. By 6 months postoperatively, visual acuity and refractive error were not significantly different from preoperative values (P > .10 for each). Conclusion: The TRASU technique is safe and can be accomplished through a conjunctival incision that averages two-thirds the size of incisions for previously reported MISS techniques.