Abstract

A 11 years old male child presented to us with right eye third nerve palsy after history of fall 1 year ago. He had pupil involvement third nerve palsy with signs of aberrant regeneration. He had 95PDXT with 35 pd Right hypotropia. Need ofstaged surgical approach was planned and t tackle such large XT, bilateral LR recession with MR resection in Le was first done followed by RE IR recessio andMR resection for residual XT and hypotropia.However there was still residual hypotropia and XT, the hypotropia causing concern to parents.With2recti already being operated in left eye furtherSRrecession was one option but with risk of Anterior segment ischemia. Right eye sup oblique medial transposition was another option but there was no intorsion and with good vision,we considered safe to tackle LE. Risk of ASI though less in children,we still choose to do vessel sparing SR recession in LE -which was a saviour in crisis.Vessel sparing gives good results in cases where chances of ASI exist .