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Surgical Technique
March 2000

Use of Apically Based Periosteal Flaps as Globe Tethers in Severe Paretic Strabismus

Author Affiliations

From the Jules Stein Eye Institute, University of California–Los Angeles School of Medicine. The authors have no proprietary interest in the products described in this article.

Arch Ophthalmol. 2000;118(3):431-437. doi:10.1001/archopht.118.3.431

Objective  To evaluate the technique of using an intact autogenous periosteal flap for tethering of the globe in patients with severe paretic strabismus.

Methods  We performed a periosteal flap procedure on 5 patients and followed their postoperative course. The flap was created from the medial, lateral, or superior orbital walls. A description of the harvesting and manipulation of the flap and the initial postoperative findings are presented.

Results  All patients showed marked reduction in their postoperative strabismic deviation compared with preoperative measurements. Greater early postoperative swelling was noted after this procedure than with the standard strabismus surgery. No complications were experienced during or after surgery. Two patients required a second operation for adjustment of the periosteal flap for adequate alignment.

Conclusions  The vascularized periosteal flap technique provides an excellent tether for the globe. Early and late stability has been favorable.