Лимбальные конъюнктивальные доступы к экстраокулярным мышцам в хирургическом лечении ранее оперированного косоглазия

Abstract

Purpose. Тo analyze clinical efficacy of the surgical treatment of previously operated strabismus using limbal incisions which are lengthening the conjunctiva and Tenon's capsule. Material and methods. The study included 440 patients (440 eyes) with previously operated strabismus at the age of 4 to 68 years old. The main group included 240 patients (240 eyes) who underwent strabismus surgery by limbal approach; the control group included 200 patients (200 eyes) who underwent surgery by paralimbal conjunctival approach. Horizontal strabismus occurred in 146 patients (60,8%) in the main group and in 158 (79%) in the control group. Horizontal strabismus in combination with vertical strabismus was found in 94 patients (39.2%) in the main group and in 42 patients (21%) in the control group respectively. The following approaches were applied: Y-shaped limbal approach, T-shaped incision of the conjunctiva, lower limbal peritomy, circular limbal approach with an additional horizontal incision towards the muscle being strengthened. Results. Good cosmetic result in the main group was achieved in 94.7% of cases, in the control group in 87% of cases, р<0.001. Re-surgery in the long term period was required for 39 patients (19.5%) in the control group and 14 patients (7%) in the main group, р<0.001. Conclusion. Limbal approaches performed to lengthening the conjunctiva and Tenon's capsule on the side of the weakened muscle and shortening on the side of the muscle being strengthened, are enhancing the effect of recession and resection, thereby contributing to the achievement of the state of orthotropy in 83% and have a good cosmetic result in 94.67% of cases. Key words: limbal conjunctival approaches, limbal conjunctival incisions, strabismus, children.