Iatrogenic Medial Rectus Loss: A Case Report

Report a case of iatrogenic medial rectus loss in exotropia surgery and its management with review literature.
Case Report: A 14-year-old female with a history of cerebral palsy and left exotropia underwent strabismus surgery in another center when she was 7 years old. As her surgeon reported, after 8 mm medial rectus resection, it was lost and he could not retrieve it; so, to balance the forces of adduction and abduction, the surgeon disinserted left lateral rectus, but 2 months later, because of large angle exotropia and severe limitation in adduction, she was referred to this center. We explored the area and could not find the lost medial rectus; so, half tendon transposition of superior rectus and inferior rectus to the previous insertion site of medial rectus was performed and left lateral rectus was fixated to the lateral orbital periosteum. Two months after the operation, she was orthotropic and ocular movements were significantly balanced.
Half tendon transposition of vertical recti to the site of lost medial rectus associated with periosteal fixation of lateral rectus can improve the strabismus of lost medial rectus muscle.