Risk of pulled-in-two syndrome
Reviewed by Fiona Rowe

Congenital fibrosis of the extraocular muscles (CFEOM) is along the risk factors for pulled-in-two syndrome (PITS). The aim of this study was to report six cases and discuss prevention and clinical management strategies. The author’s six cases represented an incidence of 0.047% (6/12652 surgeries in the study period). PITS incidence in CFEOM was 5.86% (6/102 cases). Mean age was 37.2 ±28 years. Medial rectus surgery was undertaken in five cases (three recession, one resection with transposition and one faden). The sixth case was a superior rectus plication. Muscles were not lost for any case. These were found and securely re-sutured to the sclera. Two cases were reoperations and four were first surgeries. PITS occurred under minimal tension. The authors conclude this is a rare complication and note caution and prevention is crucial in known risk cases.

Pulled-in-two syndrome in strabismus surgery for congenital fibrosis of the extraocular muscles.
Yigit DD, Inal A, Gurez C, Gokyigit B.
STRABISMUS
2023;31(2):135–8.