title: Effect of Limited Tenon Capsule and Intermuscular Membranes Dissection on the Outcome of Surgery in Patients with Horizontal Strabismus.
abstract: OBJECTIVE
  The aim of the study was to evaluate the effect of limited dissection of Tenon capsule on the outcome of strabismus surgery.
  
  
  METHODS
  Patients between the ages of 2 and 50 years with pure horizontal strabismus were enrolled in a prospective study. Patients were divided into two groups: case and control as a non-randomized study. The method of operation was similar in both groups except for the amount of sheath Tenon dissection. In the control group the intermuscular connections and Tenon capsule were cut as much as possible. In the study group, Tenon capsule, 3-4 mm posterior to the location of the sutures over the muscle (recessed or resected), were cut and intermuscular connections remained intact.
  
  
  RESULTS
  The study enrolled 54 patients with 27 patients in each group. In both groups, after operation, regardless of the type of surgery, the angle of strabismus was reduced (P< 0.05). For patients who had undergone bimedial recession, the angle of strabismus was corrected to 2.6 ± 0.4 prism diopters per mm (PD/mm) of muscle recession in the case group, and 2.2 ± 0.9 in the control group (P=0.2). For patients who had undergone monocular recession and resection (R&R) for esotropia, the angle of strabismus was corrected 3.4 ± 0.3 PD/mm of muscle recession or resection in the case group, and 3.2 ± 0.2 in the control group (P=0.05). For patients who had undergone bilateral recession, the angle of strabismus was corrected 2.3 ± 0.2 PD/mm of muscle recession in the case group, and 2.2 ± 0.2 in the control group (P=0.03). For patients who had undergone R&R for exotropia, the angle of strabismus was corrected 3.1 ± 0.5 PD/mm of muscle recession or resection in the case group, and 2.7 ± 0.3 in the control group (P=0.02).
  
  
  CONCLUSIONS
  Connective tissue ensheathments, whether disturbed or removed, do not ultimately affect the success of the strabismus surgery.
authors.affiliation: a Hospital Research Center , Tehran , Iran.
authors.forename: Maryam
authors.initials: M
authors.lastname: Aletaha
authors.affiliation: b Labbafinejad Hospital , Department of Ophthalmology , Tehran , Iran.
authors.forename: Abbas
authors.initials: A
authors.lastname: Bagheri
authors.affiliation: c Ophthalmic Research Center , Tehran , Iran.
authors.forename: Haj-Mohammad
authors.initials: HM
authors.lastname: Gholipour
authors.affiliation: c Ophthalmic Research Center , Tehran , Iran.
authors.forename: Bahareh
authors.initials: B
authors.lastname: Kheiri
mesh_terms: D000293:Adolescent; D000328:Adult; D004948:Esotropia / Q000503:physiopathology / Q000601:surgery*; D005099:Exotropia / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008566:Membranes / Q000601:surgery*; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000601:surgery*; D011446:Prospective Studies; D058475:Tenon Capsule / Q000601:surgery*; D058971:Tenotomy; D055815:Young Adult
keywords: Minimally invasive; strabismus surgery; tenon capsule