Combined horizontal rectus muscle minimally invasive strabismus surgery for exotropia

Pellanda, Niccolò; Mojon, Daniel S.

doi:10.3129/i10-016

Cited by 10 publications

(7 citation statements)

References 15 publications

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“…In another study on exotropes, Pellanda and Mojon compared the MISS approach with a historical group. [7] They found significantly less conjunctival swelling and injection on the first post-operative day (χ 2 test P < 0.001). They needed to convert 3/104 muscles in their MISS group.…”

Section: Discussionmentioning

confidence: 98%

Minimally invasive strabismus surgery versus paralimbal approach: A randomized, parallel design study is minimally invasive strabismus surgery worth the effort?

Sharma¹,

Amitava²,

Bani³

2014

Indian J Ophthalmol

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Introduction:Minimal access surgery is common in all fields of medicine. We compared a new minimally invasive strabismus surgery (MISS) approach with a standard paralimbal strabismus surgery (SPSS) approach in terms of post-operative course.Materials and Methods:This parallel design study was done on 28 eyes of 14 patients, in which one eye was randomized to MISS and the other to SPSS. MISS was performed by giving two conjunctival incisions parallel to the horizontal rectus muscles; performing recession or resection below the conjunctival strip so obtained. We compared post-operative redness, congestion, chemosis, foreign body sensation (FBS), and drop intolerance (DI) on a graded scale of 0 to 3 on post-operative day 1, at 2-3 weeks, and 6 weeks. In addition, all scores were added to obtain a total inflammatory score (TIS).Statistical Analysis:Inflammatory scores were analyzed using Wilcoxon's signed rank test.Results:On the first post-operative day, only FBS (P =0.01) and TIS (P =0.04) showed significant difference favoring MISS. At 2-3 weeks, redness (P =0.04), congestion (P =0.04), FBS (P =0.02), and TIS (P =0.04) were significantly less in MISS eye. At 6 weeks, only redness (P =0.04) and TIS (P =0.05) were significantly less.Conclusion:MISS is more comfortable in the immediate post-operative period and provides better cosmesis in the intermediate period.

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Section: Discussionmentioning

confidence: 98%

Minimally invasive strabismus surgery versus paralimbal approach: A randomized, parallel design study is minimally invasive strabismus surgery worth the effort?

Sharma¹,

Amitava²,

Bani³

2014

Indian J Ophthalmol

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“…Plausible advantages of rectus plication reportedly include simplicity; short operating time; less surgical trauma, inflammation, and hemorrhage; and early reversibility. [2][3][4][7][8][9][10][11][30][31][32] These advantages are extended by the present study's demonstration of response predictability and similarity to resection effect. Plication with minimal dissection, adapted to the small-incision technique, may offer further advantages.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5][6][7][8][9] This procedure may be performed through a small conjunctival incision with functionally and cosmetically satisfactory results. [5][6][7][8][9] Although resection typically involves deliberate severing and removal of ciliary vessels, animal studies [10][11][12] have demonstrated preservation of ciliary circulation after rectus plication, an advantage permitting more than 2 rectus muscles to undergo operative repair simultaneously in a single eye without fear of anterior segment ischemia. [10][11][12] Classic rectus muscle-to-muscle plication (tucking), as performed for the superior oblique muscle, was supposed to produce unaesthetic rectus muscle tissue overlap visible transconjunctivally.…”

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confidence: 99%

Surgical Outcomes Following Rectus Muscle Plication

Zia

Demer

2014

JAMA Ophthalmol

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IMPORTANCE Extraocular muscle strengthening is a common treatment for strabismus. Plication is an alternative procedure for strengthening muscles with less tissue trauma than resection. OBJECTIVE To compare the surgical dose effect of plication with that of resection. DESIGN, SETTING, AND PARTICIPANTS Retrospective comparison of surgical outcomes in an academic pediatric ophthalmology and strabismus practice from July 25, 2005, through March 28, 2013, with a mean follow-up of 137 days for plication and 1243 days for resection. A single surgeon performed all procedures. Twenty-two consecutive patients underwent bilateral horizontal rectus plication or plication combined with antagonist recession (13 with esotropia and 9 with exotropia; mean [SD] age, 38 [21] years). Thirty-one consecutive patients underwent bilateral resection or resection combined with antagonist recession (12 with esotropia and 19 with exotropia; mean [SD] age, 28 [24] years). Six patients underwent vertical rectus plication. EXPOSURES Rectus resection or plication performed by folding the anterior tendon posteriorly under the muscle margins oversewn to the poles of the scleral insertion, avoiding the anterior ciliary arteries. MAIN OUTCOMES AND MEASURES Postoperative binocular alignment at the first postoperative and last available examinations. RESULTS Lateral rectus plication (mean [SD], 6.5 [2.2] mm) and resection (6.6 [1.6] mm) were performed for similar magnitudes of esotropia (27.9 [13.4] prism diopters [PD] for plication, 29.0 [15.2] PD for resection; P = .44). Mean (SD) initial correction by lateral rectus plication was 5.17 (0.29) PD/mm, slightly less than the 95% CI (5.51-7.75 PD/mm) for resection (6.63 [0.50] PD/mm). Medial rectus plication (mean [SD], 4.9 [0.9] mm) vs resection (5.1 [1.1] mm) was performed for similar magnitudes of exotropia (32.8 [14.2] PD for plication, 31.2 [15.6] PD for resection; P = .33). Mean (SD) initial correction by medial rectus plication (7.10 [1.65] PD/mm) was within the 95% CI (4.65-9.87 PD/mm) for resection (7.26 [1.23] PD/mm). Initial and late effects were similar. Ciliary circulation observed at surgery remained patent after plication. Plication was cosmetically acceptable and did not produce conspicuous tissue elevations. CONCLUSIONS AND RELEVANCE Horizontal rectus muscle plication is a rapidly performed, technically simple surgical procedure to strengthen the rectus muscles, with an equivalent (per millimeter) in surgical effect to that of medial rectus resection for treatment of esotropia and exotropia. Plication diminishes surgical trauma and does not intentionally sacrifice ciliary circulation, with the potential for reversal by suture release in the first postoperative days.

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“…). For these reasons, some ophthalmologists advocated plication for surgical treatment for strabismus (Mojon ; Pellanda & Mojon ; Velez et al. ; Chaudhuri & Demer ; Wright ).…”

Section: Introductionmentioning

confidence: 99%

Comparison of bilateral medial rectus plication and resection for the treatment of convergence insufficiency‐type intermittent exotropia

Wang

Zhang

Chen

et al. 2019

Acta Ophthalmologica

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Purpose: To compare the clinical outcomes of bilateral medial rectus plication and resection for the treatment of convergence insufficiency (CI)-type intermittent exotropia (IXT). Methods: Fifty-five patients with CI-type IXT were included in this prospective study and were followed for 6 months. The patients were randomized into two groups: the bilateral medial rectus plication (BMRP) group (n = 27) and the bilateral medial rectus resection (BMRR) group (n = 28). The eye examinations of each patient were carried out before the surgery and at 1 day and 1, 3 and 6 months postoperatively. The success rate, angle of deviation, stereoacuity, operative time and postoperative conjunctival swelling and redness score were analysed. Results: The mean deviation at distance at 1 day postoperatively was +6.6 AE 5.6 prism dioptres (PD) in the BMRP group, which was lower than the value of +10.8 AE 9.3 PD observed in the BMRR group (p = 0.046). There was more overcorrection in the BMRR group at first day after surgery. However, there were no significant differences in deviations or success rates were observed between the two groups at 1, 3 and 6 months after surgery (p > 0.05). The operative time in the BMRP (12.9 AE 1.4 min) group was shorter than that in the BMRR (14.7 AE 1.4 min) group (p < 0.001). Postoperative conjunctival swelling and redness were milder in the BMRP group than in the BMRR group (p < 0.001). Conclusion: The BMRP surgery could be an alternative procedure to BMRR for the treatment of CI-type IXT with less immediate postoperative overcorrection and simpler, safer, less traumatic characteristics.

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Combined horizontal rectus muscle minimally invasive strabismus surgery for exotropia

Cited by 10 publications

References 15 publications

Minimally invasive strabismus surgery versus paralimbal approach: A randomized, parallel design study is minimally invasive strabismus surgery worth the effort?

Minimally invasive strabismus surgery versus paralimbal approach: A randomized, parallel design study is minimally invasive strabismus surgery worth the effort?

Surgical Outcomes Following Rectus Muscle Plication

Comparison of bilateral medial rectus plication and resection for the treatment of convergence insufficiency‐type intermittent exotropia

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