Voluntary ductions estimated with selleck chem a 6-point scale from 0 to �C5: 0 = eye has full movement, �C4 = eye is unable to move past the midline, and �C5 = eye cannot be moved to the midline [18]. Binocular single vision was measured using Bagolini’s striated glasses and the Harms tangent screen [19]. Surgical Method Surgical Technique for MISS Rectus Muscle Posterior Fixation The surgical procedure is performed using the operating microscope under general anesthesia. All surgical steps can be performed by the surgeon without an assistant. A limbal traction suture (SilkamS 6-0; B. Braun Medical AG, Sempach, DELETESwitzerland) is applied in order to expose the rectus muscles, which have to be weakened. During surgery, direct contact of the traction suture with the cornea has to be avoided.

Next, two small L-shaped cuts are performed slightly anterior to location where the scleromuscular sutures Inhibitors,Modulators,Libraries will be placed (fig. (fig.1c).1c). The size of the radial cut is 4 mm, the relaxing cut 2 mm. In patients with reduced elasticity of the conjunctival tissue, slightly larger openings will be necessary. In 9 eyes, the cuts were prolonged by approximately 3 mm more anteriorly in order to enable an additional minimal invasive recession or plication. The episcleral tissue is separated from the muscle sheath and the sclera with blunt Wescott scissors. Then, a curved ruler is used to determine the exact placement of the scleromuscular sutures (fig. (fig.1d).1d). The posterior fixation is performed by first passing a nonresorbable suture through the sclera (fig. (fig.

1e),1e), followed by the muscle suture, which will include one third of the muscle (fig. (fig.1f).1f). In this patient series, a PreMicron? 5-0 (B. Braun Medial AG) suture was used. The suture is tightened by a three-throw adaptation suture followed by two securing loops (fig. (fig.1g).1g). Inhibitors,Modulators,Libraries Then, using the same technique, a posterior fixation suture is placed at the other border of the muscle (fig. (fig.1h).1h). If necessary, hemostasis is performed. The surgical procedure is completed by applying single sutures (Vicryl? Rapid 8-0; Ethicon, Spreitenbach, Switzerland) to the two small cuts (fig. (fig.1i).1i). At the end of the operation, TobraDex? ointment (1 mg dexamethasone and 3 mg tobramycin per gram, 0.5% chlorobutanol) or Maxitrol? ointment (polymyxin B sulfate, 6,000 units, neomycin sulfate, 3,500 units, dexamethasone 1.

0 mg, methylparaben 0.05%, and propylparaben 0.01%) were applied. No eye patch Inhibitors,Modulators,Libraries was used. For the first 2 weeks after surgery, the following treatments were prescribed: TobraDex? suspension (1 mg dexamethasone Inhibitors,Modulators,Libraries and 3 mg tobramycin per milliliter, 0.01% benzalkonium chloride) Inhibitors,Modulators,Libraries t.i.d. and TobraDex? ointment in the evening Brefeldin_A or Maxitrol? suspension (polymyxin B sulfate, 6,000 units, neomycin sulfate, 3,500 units, dexamethasone 1.0 mg, and benzalkonium chloride 0.004%) t.i.d. and Maxitrol? ointment in the evening.