title: Use of apically based periosteal flaps as globe tethers in severe paretic strabismus.
abstract: OBJECTIVE
  To evaluate the technique of using an intact autogenous periosteal flap for tethering of the globe in patients with severe paretic strabismus.
  
  
  METHODS
  We performed a periosteal flap procedure on 5 patients and followed their postoperative course. The flap was created from the medial, lateral, or superior orbital walls. A description of the harvesting and manipulation of the flap and the initial postoperative findings are presented.
  
  
  RESULTS
  All patients showed marked reduction in their postoperative strabismic deviation compared with preoperative measurements. Greater early postoperative swelling was noted after this procedure than with the standard strabismus surgery. No complications were experienced during or after surgery. Two patients required a second operation for adjustment of the periosteal flap for adequate alignment.
  
  
  CONCLUSIONS
  The vascularized periosteal flap technique provides an excellent tether for the globe. Early and late stability has been favorable.
authors.affiliation: Jules Stein Eye Institute, University of California-Los Angeles School of Medicine, 90095, USA.
authors.forename: R A
authors.initials: RA
authors.lastname: Goldberg
authors.forename: A L
authors.initials: AL
authors.lastname: Rosenbaum
authors.forename: J T
authors.initials: JT
authors.lastname: Tong
mesh_terms: D000368:Aged; D002675:Child, Preschool; D005133:Eye Movements; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D013508:Ophthalmologic Surgical Procedures; D009915:Orbit / Q000601:surgery*; D010521:Periosteum / Q000601:surgery*; D013285:Strabismus / Q000601:surgery*; D013524:Surgical Flaps; D015348:Vision, Binocular