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To evaluate the clinical safety and efficacy of the novel Wright hang-back recession with fibrin glue for the treatment of horizontal strabismus.Retrospective, case-controlled clinical study comparing surgical outcomes of the Wright hang-back rectus recession with fibrin glue (WHBG) versus standard fixed suture rectus recession (SFR).Medical records of all patients who underwent strabismus surgery by one strabismus surgeon between 2016 and 2018 for horizontal deviations only, including cases of WHBG (group 1) or SFR (group 2), were reviewed. Good surgical outcome was defined as a postoperative deviation ≤10 prism diopters (PD) at a minimum 2 months of follow-up.32 eyes of 17 patients underwent WHBG and 32 eyes of 17 patients underwent SFR; in each group, 35% had esotropia and 65% had exotropia. Mean preoperative deviations between groups were similar: esotropia 25.5 PD and exotropia 26.6 PD in WHBG; esotropia 28.3 PD and exotropia 23.8 PD in SFR. The mean postoperative deviation was7 PD for both groups. Good surgical outcomes were similar between groups, 16/17 (94%) in WHBG and 15/17 (88%) in SFR, with no complications.WHBG was safe and effective with postoperative results similar to SFR. WHBG has an important advantage, eliminating the complication of retinal perforation that can occur with SFR while avoiding under- or overcorrection that can occur with traditional hang-back recession. This technique increases patient safety without sacrificing surgical outcomes and is especially useful in patients with thin sclera such as patients with high myopia or with difficult posterior exposure.

Standard rectus muscle recessions require suturing muscle to sclera posterior to the insertion, which is dangerous as the sclera is thin. Extraocular muscle hang-back recession can avoid the posterior scleral needle pass but has been reported to be unstable. The purpose of this study is to assess the use of N-butyl-2-cyanoacrylate to aid reattachment of rectus muscle to sclera during hang-back recession.2 Phase Study: Phase 1 was a wet lab animal study; Phase 2 was a small case series.Phase 1, 14 frozen bank rabbit heads; Phase 2, 4 human adult patients with myopia and large exotropia.Phase 1: Frozen bank rabbit heads were used to simulate human hang-back rectus muscle recession. Fourteen rectus muscles were recessed by hang-back and glued to sclera with either cyanoacrylate glue alone (group 1) or glue over prolene mesh for greater stability (group 2). Primary outcome was muscle detachment force measured at 20, 30, and 40 seconds. Phase 2: Four patients with myopia and large exotropia who underwent bilateral hang-back lateral rectus recessions with cyanoacrylate glue were retrospectively studied.Phase 1: Group 1 mean detachment force measured at 30 seconds was 172.07 g versus 376.5 g in group 2 (p0.01). Phase 2: All patients had excellent postoperative alignment within 5 PD of orthophoria and no overcorrections. Two patients had unilateral glue extrusion at 1 month requiring in-office removal under topical anaesthesia.Cyanoacrylate glue with or without mesh resulted in adequate muscle-to-sclera adhesion with a detachment force at least 2 times the force of a normal rectus muscle contraction. Patients undergoing hang-back lateral rectus recession with cyanoacrylate glue had excellent stable postoperative alignment; however, half had the complication of late extrusion of glue foreign body.