Plication as an alternative to resection in horizontal strabismus: A randomized clinical trial

Abstract

Purpose:Resections and plications tighten recti although the latter are less traumatic, potentially reversible, quicker, and vascularity preserving. To compare inflammation, scarring, and alignment in horizontal strabismus, operated uniocularly by either resections or plications (with recessions): recession and resection (R&R) or recession and plication (R&P) groups. This was a prospective, patient and assessor blind, randomized trial.Methods:All consenting strabismus patients qualifying for the first-time uniocular horizontal rectus surgeries underwent detailed ocular examination and were randomized into standard R&R or R&P groups. For the latter, we folded the tendon-muscle strap the desired amount using 6-0 polyglactin, suturing it to its insertion, entailing no disinsertion. We compared the groups for inflammatory grades (individually for congestion, chemosis, discharge, foreign-body sensation, and drop intolerance and aggregated to a total inflammatory score (TIS), scar visibility (SV) at 1 m, and successful alignment (≤10 prism diopter of orthotropia). We used Mann–Whitney and Fisher's exact tests, with significance at P ≤ 0.05.Results:We randomized 40 patients: 22 to R&R and 18 to R&P. The groups were comparable in age, strabismus onset and duration, and strabismus amount. The inflammatory scores, both individual and TIS, were comparable at all time-points: all P > 0.05. SV proportions were not significantly different: 16/22 in R&R versus 9/18 in R&P; P = 0.19. There were no significant differences in success rates: 14/22 versus 10/18, P = 0.74.Conclusion:Our study shows that plication is similarly effective as resection, when combined with recession in horizontal strabismus, and should be resorted to more frequently.

Postoperative Closed-Suction Drain in Anterior Orbitotomy

“…The presence of a drain, therefore, did not prolong the hospital stay for any patient. This is in contrast to studies on laparoscopic cholecystectomy and thyroid surgery associated with extended duration of hospital stay and greater chances of infection in the drain group [17,18]. Notably, none of the patients in either group developed any orbital compartment syndrome.…”

“…Eyelid swelling was measured using a four-grade scale method developed by Gurlek et al [ 17 ], ranging from phases 0 to 4, where phase 1 encompassed minimal edema, phase 2 represents open eyelids reaching the iris due to the effect of edema, phase 3 involved open eyelids showing only the pupils due to the effect of edema, and phase 4 comprised eyelids completely closed due to generalized edema. Ecchymosis [ 18 ] was assessed on a slit lamp examination graded from nil to mild, moderate, and severe, resulting in a score between 0 and 3, where mild being just visible, moderate denotes fairly obvious, and severe represents protruding out.…”

Sliding Shape Extraocular Muscle Transposition with Plication: Novel Method

“…In some indications, for example, monocular elevation deficiency (MED) with horizontal deviation, patients need three muscles surgery in the same eye (1,2). In the treatment plan, one muscle needs both transposition procedure with resection and the blood supply protection for preventing anterior segment ischemia (2).…”

Plication: How apt in application?

“…Prabha, et al . [ 4 ] describe the comparative outcomes of standard resection procedure with plication of rectus muscles. The authors have shown comparable outcomes of both the procedures.…”