Use of apically based periosteal flaps as globe tethers in severe paretic strabismus

Objective: To evaluate the technique of using an intact autogenous periosteal nap 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.