The effect of rectus muscle recession, resection and plication on anterior segment circulation in humans

Abstract

Background Plication is an alternative tightening procedure to resection. In monkeys, plication has been shown to preserve anterior segment circulation compared with full-tendon tenotomy, but this is unconfirmed in humans. Purpose To evaluate anterior segment circulation by iris angiography before and after strabismus surgery in humans. Methods Prospective, blinded study of 14 patients (mean age (SD), 58.6 (14.3)) undergoing plication and/ or full tendon tenotomy (resection or recession) from August 2013 to March 2014. Eight patients (mean age (SD), 59.0 (13.3)) underwent plication of one muscle with or without recession of a second muscle on the same eye and six patients (mean age (SD), 58.2 (16.8)) underwent tenotomy of one to two muscles on the same eye. Preoperative and postoperative iris angiograms were compared for changes in perfusion by a masked examiner. In patients undergoing binocular surgery, one eye was chosen preoperatively to be the study eye. Results Postoperative iris filling defects were present in four patients (67%) after tenotomy and one patient (12.5%) after plication (p=0.09). Of the seven total vertical rectus muscles operated (three tenotomies and four plications), filling defects were present after three tenotomies and one plication (100% vs 25%; p=0.14). Of the 13 total horizontal rectus muscles operated (eight tenotomies and five plications), filling defects were present after one tenotomy and none of the plications (13% vs 0%; p=0.99). Conclusions Rectus muscle plication spares the ciliary vessels and may be considered a safer alternative to resection for patients at risk for anterior segment ischaemia, especially when surgery involves a vertical rectus muscle.

Adjustable small-incision selective tenotomy and plication for correction of incomitant vertical strabismus and torsion

“…Surgery on multiple rectus muscles may risk anterior segment ischemia, whereas anterior ciliary circulation may be partially spared with selective tenotomy or plication. 12 For these reasons, it may be desirable in some situations to consider selective tenotomy or plication for correction of cyclotorsion as these procedures can be performed with adjustable sutures, less risk of anterior segment ischemia, and under topical anesthesia, in some cases.…”

“…Plication has multiple advantages over resection, including sparing of anterior ciliary blood supply, 12 reversibility, and avoiding risk of a lost muscle. We describe a new technique of selective plication in which only one pole of a vertical rectus muscle is plicated.…”

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

“…Several advantages of plication have been described in previous studies including absence of risk of lost muscle, early reversibility and preservation of anterior ciliary arteries (Chaudhuri & Demer ; Oltra et al. ). For these reasons, some ophthalmologists advocated plication for surgical treatment for strabismus (Mojon ; Pellanda & Mojon ; Velez et al.…”

Plication versus Resection in Horizontal Strabismus Surgery

“…Plication may have certain benefits over resection, such as being less invasive with less surgical trauma [8,11,12], inflammation, and haemorrhage. It can be performed faster than a resection [13], and circulation of the anterior ciliary arteries may be preserved [11,14,15]. Since plication does not require separation of the muscle from the globe, it has no risk of slipped or lost muscles in the postoperative period [14].…”