Lateral rectus posterior fixation suture

Background: Some authors have suggested that a posterior fixation suture on the lateral rectus muscle is ineffective because of the muscle's long arc of contact with the globe. We report a small case series of patients successfully treated using a lateral rectus posterior fixation suture. Methods: The surgical database of one surgeon (JMH) was reviewed for all patients undergoing lateral rectus posterior fixation surgery for mechanical or paretic strabismus. In all cases, the lateral rectus muscle was disinserted from the sclera, and a Mersilene posterior fixation suture was placed 17 mm to 19 mm back from the insertion. The lateral rectus muscle was simultaneously recessed in all cases using a novel approach to allow adjustment of the recession if needed while maintaining the posterior fixation suture. Outcome was assessed at least 1 year after surgery. Results: Three patients were identified. Adduction deficit of the affected eye was caused by previous sinus surgery in 2 cases and scleral buckle surgery in 1 case. The lateral rectus muscle posterior fixation suture on the unaffected eye induced the planned matching -1 limitation of abduction, with resulting improvement in incomitance of the exotropia and reduced angle of exodeviation on prism cover testing. Conclusions: In this case series, a lateral rectus muscle posterior fixation suture was useful in addressing incomitant exodeviations. It is unknown whether this technique is superior to alternative surgical approaches.