Dr. MIHIR TRILOK KOTHARI

Dr.Meghna Solanki, Dr.Susha Sugathan

Abstract

Aim: To describe a novel technique of HTTSMR. Subject: A 9 year old boy underwent the procedure for diplopia, v pattern +35PD esotropia and hypertropia, following partial orbital exenteration, radiotherapy and chemotherapy for embryonal rhabdomyosarcoma of the right lateral rectus. Methods: The Holmes dots were marked, MR was split for 15mm into upper 1/3rd that was recessed by 12mm and lower 2/3rd through Swan incision. The lower portion was transposed temporally beneath the inferior rectus and attached below insertion of LR with a posterior fixation suture. Postoperatively patient had orthotropia, good abduction, adduction, 25 degrees of binocular single field and a quiet eye. Conclusion: HTTSMR is a new, minimally invasive approach for the management of 6th nerve palsy. The advantages include good adduction, abduction, post op comfort, adjustability to refine post op alignment and adduction without complication of consecutive exotropia, compression neuropathy and vasculopathy.