Dr. MIHIR TRILOK KOTHARI

Dr.Meghna Solanki, Dr.Susha Sugathan

Abstract

This novel, minimally invasive surgery involves temporal transposition of lower half of medial rectus (MR). The procedure involves 1) Marking Holmes dots, 2) Two conjunctival incisions, one each in infero-nasal and infero-temporal fornices, 3) Splitting of MR for 15mm posteriorly, 4) Application of 6’o vicryl on the lower half, 5) Disinsertion of the lower half, 6) Sliding the disinserted MR under the globe beneath the inferior rectus muscle temporally, 7) Suturing the MR below inferior border of LR.

Transposition forces can be augmented by a) Recession of the upper half of MR if FDT +ve, b) Resection of the transposed half or addition of a posterior fixation suture simultaneously.

In comparison with vertical rectus transpositions, HTTSMR is simpler, faster, more effective, preserves vascular and septal anatomy and produces less inflammation. Compared to full thickness MR transposition, there is reduced chance of exotropia, neurovascular compression and better post op adduction.