Purpose: Sometimes, a conventional recess-resect surgery may not be sufficient to obtain satisfactory ocular alignment. Patients who have previously undergone surgery and/or have a large difference in visual acuity between both eyes and do not wish to undergo surgery on the sound eye provide a surgical challenge. In these cases, tendon elongation with bovine pericardium may be an option.
Methods: We retrospectively reviewed the charts of 38 patients who underwent strabismus surgery with tendon elongation. Before surgery, 31 had exotropia (angle -21.8 ± 5.7 degrees) and 7 esotropia (angle +19.1 ± 5.4 degrees). Reasons for tendon elongation included the following: 15 patients refused surgery on their sound eye; in 15 patients, conventional recess-resect was not possible; and in 7 patients, the elongation best fitted the motility pattern. In one patient, tendon elongation was preferred over conventional recession because of a thin sclera. Follow-up was 0.5 to 4 years.
Results: At last follow-up visit, in patients with previous exotropia, the angle was -3.3 ± 5.9 degrees; in patients with previous esotropia, +0.2 ± 0.5 degrees. Most had some duction limitation in the direction of the elongated muscle. All patients but one were satisfied with the result. In the patients with previous exotropia, there was a small but nonsignificant regression to recurrence of the exodeviation (on average 0.5 degree per year).
Conclusions: Tendon elongation is a valuable addition to our strabismus surgery repertoire. However, because of duction limitations after surgery, it should be reserved for those cases in which conventional surgery is not an option.