Minimally invasive strabismus surgery versus paralimbal approach for horizontal strabismus surgery

Background Minimal invasion surgeries have gained popularity in many fields of ophthalmology. In strabismus surgery, a similar approach is done to gain access to muscles, which is performed through keyhole openings. Objective To compare between minimal invasive strabismus surgery (MISS) technique and limbal approach for horizontal rectus muscle regarding postoperative muscular alignment and postoperative complications. Patients and methods This study included 60 eyes (36 patients of different age and sex) presenting with horizontal strabismus. The first group included 30 eyes that were managed by MISS (patient group), and the second group included 30 eyes that were managed by the limbal approach (control group). Results No significant difference was found regarding postoperative pain, conjunctival redness, and ocular alignment. There was no significant increase in complications between the two groups. Operative time was longer in the MISS technique, with highly significant difference between the two groups. Conclusion MISS technique is an alternative technique to limbal incision that can be used on horizontal muscles. It has the same effect as the limbal approach with the same success rate. It has the advantages of sparing perilimbal episcleral vessels, which make some surgeon prefer it if there is fear of anterior segment ischemia.