Minimally Invasive Strabismus Surgery

In October 1839, only a few days apart, two surgeons independently performed the first documented successful myotomy to improve strabismus. In Berlin, Johann Friedrich Dieffenbach myotomized one medial rectus muscle in an esotropic boy while Florent Cunier of Brussels myotomized one lateral rectus muscle to cure an exodeviation [29]. Probably, already in 1818, William Gibson of Baltimore had myotomized several patients. However, because of the disappointing results, he failed to report it until 1841. Since these early beginnings of strabismus surgery, many different operating techniques for rectus and oblique eye muscles have been described, making surgical outcome more predictable. This chapter is devoted to minimally invasive approaches to strabismus surgery. All techniques being reviewed aim to reduce tissue traumatism, postoperative patient discomfort, hospital stay and working disability. For such techniques it is advisable to use the operating microscope which will allow higher magnifi-cations than magnifying spectacles. A better view of the operating site allows a less traumatic tissue dissection and a better control of bleeding. Chemodener vation therapy, which can also be considered a minimally invasive procedure, will not be appraised since excellent literature on that topic already exists [1, 18–20].