Fenestration Technique Offers Sutureless Surgery for Strabismus

Eyelid muscles on operating table.
A study shows the approach’s safety and efficacy is comparable to muscle recession.

Muscle fenestration can correct horizontal or vertical strabismus with safety and efficacy comparable to a classic muscle recession approach, according to a study published in Clinical Ophthalmology. The fenestration technique employs a weakening maneuver to the horizontal and vertical extraocular muscles that does not require surgeons to utilize sutures or botulinum toxin.

The trial looked at 18 patients who had surgical correction of horizontal or vertical strabismus during May to July 2020. Patients who were male or female aged 1- to 60-years-old and admitted to the Pediatric Ophthalmology and Strabismus Department at the Research Institute of Ophthalmology, Egypt for surgical correction of horizontal or vertical strabismus from May to July 2020 were included. They were randomly grouped by the envelop method as either: Group 1 (fenestration group, n=9) or group 2 (recession group, n=9). Patients were assessed at the first postoperative day, 1 week, and 1 month after surgery.

Researchers explain that the “fenestration technique reduces the muscle force by removing a block of the muscle close to its insertion which is done in between 2 peripheral muscle strips. It is a promising simple technique that might avoid the complications of using sutures such as foreign body reactions and granuloma formation.”

The study shows that postoperative ocular alignment at the first day, 1 week, and 1 month after surgery had comparable results, with no significant differences, between both groups (P >.05). But they did find that the median postoperative pain score at the first day following the operation was significantly higher in the fenestration group than the recession group (medians were 2.0 and 1.0, respectively, P =.014). However, the medians of the pain score were equal in both groups by 1 week and 1 month postoperatively (P >.999). 

In the fenestration group, 1 patient developed a progressive subconjunctival hemorrhage; the recession group had no postoperative complications (P >.999). 

“Given the comparable efficacy and safety of the fenestration and classic recession here in, there are clear advantages of the fenestration technique over the classic recession, namely, easy surgical procedure and being entirely sutureless. Lack of suturing reduces the risk of scleral perforation which is a possible major complication with any procedure [that involves a] partial thickness scleral suture,” according to the researchers.

The study’s limitations are its small sample size and short follow-up.


Taher SG, Rageh MA, Hashem O. Extra ocular muscle fenestration as a weakening maneuver for surgical management of strabismus: a randomized pilot clinical trial. Clin Ophthalmol. 2022;16:63-70. doi:10.2147/OPTH.S347092