title: Cul-de-sac incision for strabismus surgery in older patients.
abstract: BACKGROUND
  A limbal surgical approach for strabismus surgery is often recommended for older patients, in the belief that the conjunctiva of older patients is too thin and prone to tear during surgery performed through a cul-de-sac incision. The purpose of this study was to evaluate the use of the cul-de-sac approach in patients more than 40 years of age.
  
  
  METHODS
  This is a retrospective analysis of consecutive patients more than 40 years of age who underwent strabismus surgery using a modified cul-de-sac approach to reduce manipulation of the conjunctiva during surgery.
  
  
  RESULTS
  A total of 32 cul-de-sac incisions were used to operate on 37 muscles in 19 consecutive patients more than 40 years old. The man age was 58 yeasr (41-77 years) with 8 patients (12 incisions) more than 60 years old. Absorbable sutures were used to close 28 of the incisions, with 19 incisions requiring 1 suture, 7 requiring 2 sutures, and 2 incisions in 2 patients requiring more than 2 sutures. Tears resulting in extension of the conjunctival incision occurred in several patients, but no other complications were encountered. One week following surgery, 28 (87.5%) of the incisions were well closed, while a small opening was noted with 4 (12.5%) of the incisions, but none required further intervention, and all healed well.
  
  
  CONCLUSIONS
  Strabismus surgery can be performed through a cul-de-sac incision in older patients. Slight modifications of the surgical technique to prevent excessive manipulation of the incision and to reduce the risk of tearing the conjunctiva are helpful. The cul-de-sac approach offers some important potential advantages to older patients undergoing strabismus surgery.
authors.affiliation: Cullen Eye Institute, Departments of Ophthalmology and Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA. dkcoats@texaschildrenshospital.org
authors.forename: David K
authors.initials: DK
authors.lastname: Coats
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures; D013285:Strabismus / Q000601:surgery*