Fornix Based Incision for Strabismus Surgery

1. Saurabh Jain^1,2
2. Naomi Tan^1,2
3. Rohit Jolly^1,2

¹Royal Free Hospital, London, United Kingdom
²University College London, London, United Kingdom

Purpose
The commonest technique used to access the extraocular muscles in squint surgery is via a limbal incision in the conjunctiva. A recent advance in technique has been the use of a fornix based incision. We describe the fornix incision for strabismus surgery, demonstrate the technique in a video and discuss the benefits and shortcomings of this technique.

Methods
The fornix based incision has been used for the past one year with encouraging results in our centre. This incision in any of the four conjunctival quadrants can allow access to two rectus muscles and one oblique. It has several key advantages over the limbal approach. These include greater ease and speed of construction and closure, increased post operative comfort and improved immediate cosmetic outcome. The fornix incision causes less episcleral adhesions than the limbal approach, which facilitates re-access in the event that further surgery is required.

The fornix approach has certain limitations. It is particularly difficult in patients with thin conjunctiva, for example patients over 35 years of age. The limbal approach provides excellent exposure of the site and remains indicated in "re do" surgery or where postoperative adjustment is anticipated. The fornix based incision technique can be challenging to learn.

Conclusions
The fornix based incision is a viable alternative to the limbal incision and is likely to have an important impact on clinical practice in squint surgery with increasing popularity.

Results
We have produced a comprehensive teaching video with commentary which demonstrates the fornix incision for squint surgery.