The relative frequency of scleral perforation during strabismus surgery and its definite, though small incidence of serious complications suggest that marginal myotomy should have a definite role in muscle weakening. Yet it is seldom used, mainly because of the difficulty in grading the amount of weakening as can be done with a recession.
As an alternative to marginal myotomy or recession in patients with abnormally thin sclera, we have used a measured tendon-lengthening procedure that combines the smoothly graded and predictable responses of recession with the safety of marginal myotomy.
Klein RM, Muchnick RS, Raskind RH. Measured Tendon Lengthening. Arch Ophthalmol. 1974;92(4):309-311. doi:10.1001/archopht.1974.01010010319011