Tendon Elongation with Fascia Lata Grafts in Strabismus Surgery – Multiple Indications Apart from Gravesʼ Orbitopathy

Abstract

Background To investigate the use of fascia lata (FL) grafts for eye muscle tendon elongation in patients with complex and residual strabismus types apart from Gravesʼ orbitopathy.

Methods and Materials In this retrospective study, a heterogeneous group of 27 eyes of 21 patients with complex and residual strabismus types who underwent elongation of the eye muscle tendon with FL were included. Orthoptic and ophthalmological examinations including measurement of the head posture, the extent of deviation in primary position (PP), and monocular excursion were conducted preoperatively and after a mean postoperative time of 12.2 (6.0 – 37.0, median 7.0) months in all patients.

Results Eight patients (12 eyes) with residual exotropia, 4 patients (4 eyes) with residual esotropia, 4 patients (6 eyes) with partial abducens nerve palsy, 4 patients (4 eyes) with vertical deviation, and 1 patient (1 eye) with Duaneʼs retraction syndrome (DRS) type I were included. A residual squint angle of 10Δ or less was achieved in 57.1% of the patients at the last follow-up. The head posture was significantly reduced at the last follow-up compared to preoperatively in patients with residual exotropia (p = 0.002), esotropia (p = 0.040), abducens nerve palsy (p = 0.005), and vertical deviation (p = 0.005). At the last follow-up, a significant reduction in the squint angle occurred in patients with residual exotropia (p = 0.001), abducens nerve palsy (p = 0.046), and vertical deviation (p = 0.033).

Conclusion FL grafts may offer safe and effective surgical options for complex and residual strabismus types. No significant reduction in the excursion into the fields of action of the affected muscles was witnessed.

Zusammenfassung

Hintergrund Untersuchung der Verwendung von Fascia-lata-Transplantaten (FL-Transplantaten) zur Verlängerung von Augenmuskelsehnen bei Patienten mit komplexen und residualen Strabismusformen, ausgenommen die endokrine Orbitopathie.

Methoden und Material In dieser retrospektiven Studie wurde eine heterogene Gruppe von 27 Augen von 21 Patienten mit komplexen und residualen Strabismusformen eingeschlossen, die eine Verlängerung der Augenmuskelsehnen mittels FL-Transplantaten erhielten. Orthoptische und ophthalmologische Untersuchungen, einschl. der Messung der Kopfzwangshaltung, des Schielwinkels in Primärposition (PP) sowie der monokularen Exkursion, wurden präoperativ und nach durchschnittlich 12,2 Monaten (6,0 – 37,0, Median 7,0) postoperativ durchgeführt.

Ergebnisse Es wurden 8 Patienten (12 Augen) mit residualer Exotropie, 4 Patienten (4 Augen) mit residualer Esotropie, 4 Patienten (6 Augen) mit partieller Abduzensparese, 4 Patienten (4 Augen) mit vertikaler Deviation sowie 1 Patient (1 Auge) mit Duane-Retraktionssyndrom (DRS) Typ I eingeschlossen. Ein residualer Schielwinkel von 10 Δ oder weniger wurde bei 57,1% der Patienten bei der letzten Nachuntersuchung erreicht. Die Kopfzwangshaltung war im Vergleich zur präoperativen Untersuchung bei Patienten mit residualer Exotropie (p = 0,002), Esotropie (p = 0,040), Abduzensparese (p = 0,005) und vertikaler Deviation (p = 0,005) signifikant reduziert. Zudem zeigte sich eine signifikante Reduktion des Schielwinkels bei Patienten mit residualer Exotropie (p = 0,001), Abduzensparese (p = 0,046) und vertikaler Deviation (p = 0,033) zum Zeitpunkt der letzten Nachkontrolle.

Schlussfolgerung FL-Transplantate stellen eine sichere und effektive chirurgische Option für komplexe und residuale Strabismusformen dar. Es wurde keine signifikante Einschränkung der Exkursion in die Wirkungsrichtungen der betroffenen Muskeln beobachtet.

Conclusion

Already known:

• Large squint angles might occur in patients with Gravesʼ orbitopathy and in complex ocular motility disorders. However, recessions of eye muscles are limited.

• Tendon elongation with graft materials might be necessary in patients with large squint angles.

• Different graft materials have been used for tendon elongation, including allograft, xenograft, and artificial material

Newly described:

• According to the main findings of the present study, eye muscle tendon elongation with FL is a safe and effective procedure in indications apart from Gravesʼ orbitopathy.

• Future studies with larger sample sizes and longer follow-up periods should further investigate dose-effects and possible duction limitations.

Keywords

tendon elongation - fascia lata - strabismus - strabismus surgery

Schlüsselwörter

Sehnenverlängerung - Fascia lata - Strabismus - Strabismuschirurgie

Publication History

Received: 17 November 2023

Accepted: 12 May 2025

Article published online:
16 June 2025

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