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To the Editor.
—Dr. John Kennedy recommends the marginal myotomy, as described by Morgan, as the initial weakening procedure of the medial recti for esotropia in infants because the recession procedure is difficult in the infant, and buried sutures often cause excessive reaction and consequent limitation of abduction due to scar formation (Arch Ophthal84:625-626, 1970). I have performed recession of the medial recti in several hundred infants over the past 23 years and find the procedure to be no more difficult in infants than adults provided small instrumentation and sutures are used. Nor am I aware of excessive reaction caused by the buried sutures with consequent limitation of abduction due to scar formation.Most disturbing to me is Dr. Kennedy's advice to perform a crippling procedure on a muscle as the initial surgery for strabismus, The primary objective of the strabismus surgeon should be to manipulate the
Marshall M. Parks. MARGINAL MYOTOMY. Arch Ophthalmol. 1971;85(5):639. doi:10.1001/archopht.1971.00990050641024