Polytetrafluoroethylene in the surgery of cases with severe limitation of abduction Long-term results

Background: In cases of severe palsy or paralysis of eye muscles, it is sometimes necessary to extensively weaken the homolateral antagonist. Large recessions reduce the ocular motility by shortening the arc of contact between muscle and sclera. The lengthening of the muscle tendon with Fascia lata, Lyo-Dura®, or the free transplantation of an excided piece of autologous eye muscle tendon does not ensure predictable precise results. We used polytetrafluoroethylene (PTFE, Gore-Tex®) for seven years and report on our results. Method: A new technique is introduced in which the muscle is lengthened by PTFE. Ten patients (7 sixth nerve palsies, 1 strabismus fixus, 2 Duane’s retraction syndromes) underwent lengthening of the medial rectus muscle with a Gore-Tex® soft tissue patch between 8 and 14mm in size. The two patients with the Duane's retraction syndrome were not operated on the rectus externus muscle. All other patients had a resection of the paralytic muscle. Results: In most cases, good results were obtained: binocular single vision in primary head position within a small field of fusion. Histological examination of a specimen of Gore-Tex® four years after surgery showed an excellent integration of the graft into the tissue. Fibrous connective tissue wrapped the Gore-Tex® like a capsule. There were no signs of inflammation or graft reaction. Conclusions: PTFE (Gore-Tex® Soft Tissue Patch) is a suitable material for complicated strabismus surgery. Main advantages: availability at any time in the operation theater; high biocompatibility; form stability; and no diminution of operative results.