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

Abstract

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.

Plication versus Resection in Horizontal Strabismus Surgery: A Systematic Review with Meta-Analysis

“…e grouped success rate for plication was 66% (95% CI � [43%-89%]). Only the first three studies presented similar rates (between 50% and 87%) [16][17][18] (Figure 1). e grouped success rate for resection was 68% (95% CI � [43%-89%]) ( Figure 2).…”

“…Wang et al [ 17 ] in a prospective study analyzed 55 patients with convergence insufficiency-type intermittent exotropia. The authors divided the patients in two groups according to procedure (27 who were submitted to bilateral medial rectus plication and 28 to resection).…”

“…Kimura and Kimura [16] demonstrated stereoacuity only before surgery, and there was no difference between groups (p � 0.23). Wang et al [17] showed that near stereopsis was improved in 44% patients in the plication group and 54% in the resection group (p � 0.48). Chaudhuri and Demer [5] showed that stereopsis improved in 6 of 9 patients submitted to plication and 7 of 19 patients submitted to resection in the exotropia group.…”

“…But, in general, we did observe the numerical similarity on the amount of exodrift between groups in the postoperative follow-up. e overcorrection rate was analyzed in four studies in which patients were treated for exotropia [11,[16][17][18].…”

Management of Abnormal Visual Developments

“…Surgery for correcting strabismus is performed based on strengthening or weakening the extraocular muscle. There are various types of strabismus surgery, including rectus muscle recessions, resections, and plications [39,40,77], rectus muscle transpositions, inferior oblique recessions, rectus muscle posterior fixations, and so on. The amount of surgery and the choice of surgical technique may vary.…”