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A modified technique for rectus muscle plication in minimally invasive strabismus surgery
1Department of Strabismology and Neuro-Ophthalmology, Kantonsspital St. Gallen, St. Gallen, Switzerland. daniel.mojon@kssg.ch
Purpose:
To present a novel, minimally invasive strabismus surgery (MISS) technique for faster and less invasive rectus muscle plication.
Methods:
The new plication method is performed without spatula and, therefore, instead of a total dissection (TODI) only a marginal dissection (MADI) of the plicated part of the muscle is performed. Forty patients operated with combined, horizontal MISS rectus muscle recession/MADI plication are retrospectively compared to a similar group of 49 patients, who had MISS recession/TODI plication. The following outcome parameters were analyzed: alignment, binocular single vision, variations in vision, refraction, conjunctival abnormalities, dose-response relationship, and number and types of complications during the first 6 postoperative months.
Results:
Postoperatively, the conjunctiva over the plicated muscle was less swollen and red with MADI compared to TODI plication (p < 0.01). In esodeviations, there was no significant difference in the dose-response relationship between MADI and TODI plication (1.38 +/- 0.44 vs. 1.44 +/- 0.50 degrees /mm, p > 0.1). In exodeviations, the difference between MADI and TODI plications was not significant either (1.41 +/- 0.38 vs. 1.42 +/- 0.50 degrees /mm, p > 0.1). Also final alignment, binocular single vision, visual acuities, refractive changes, or complications did not differ between the two techniques.
Conclusions:
This study demonstrates that MADI plication is feasible and equally effective in comparison with the TODI plication technique when performing MISS. MADI plication, which is performed without spatula, allows to considerably further reduce postoperative conjunctival swelling and redness.
Insights
A new minimally invasive strabismus surgery (MISS) rectus muscle plication technique, marginal dissection (MADI), reduces conjunctival swelling and redness compared to total dissection (TODI). MADI is equally effective for strabismus correction.
Area of Science:
- Ophthalmology
- Surgical Techniques
Background:
- Strabismus surgery aims to restore ocular alignment.
- Minimally Invasive Strabismus Surgery (MISS) techniques are evolving to reduce patient morbidity.
- Rectus muscle plication is a common surgical approach.
Purpose of the Study:
- To introduce and evaluate a novel, minimally invasive strabismus surgery (MISS) technique for rectus muscle plication.
- To compare the outcomes of marginal dissection (MADI) plication with total dissection (TODI) plication.
Main Methods:
- A retrospective comparison of 40 patients undergoing MISS recession/MADI plication versus 49 patients undergoing MISS recession/TODI plication.
- Analysis of postoperative alignment, binocular single vision, visual acuity, refraction, conjunctival abnormalities, dose-response, and complications over 6 months.
Main Results:
- MADI plication resulted in significantly less conjunctival swelling and redness postoperatively compared to TODI plication (p < 0.01).
- No significant differences were observed between MADI and TODI plication in terms of dose-response for esodeviations or exodeviations.
- Final alignment, binocular single vision, visual acuity, refractive changes, and complication rates were similar between the two techniques.
Conclusions:
- Marginal dissection (MADI) plication is a feasible and effective alternative to total dissection (TODI) plication in MISS.
- MADI plication, performed without a spatula, offers the advantage of reduced postoperative conjunctival inflammation.
