Central Mini-plication of the Medial Rectus for Convergence Insufficiency

Area of Science:

• Ophthalmology
• Strabismus Surgery

Background:

• Convergence insufficiency (CI) in adults can cause debilitating symptoms like diplopia and exotropia.
• Non-surgical treatments such as vision therapy and prisms are often the first line of management.
• When conservative measures are insufficient or rejected, surgical intervention may be considered.

Observation:

• This study describes the outcomes of central mini-plication of the medial rectus (MR) muscles in five adult patients with CI, diplopia, and near exotropia.
• The mean age of patients was 61 years, with a mean preoperative deviation of 18 pd.
• Four out of five patients underwent unilateral MR muscle surgery.

Findings:

• Central mini-plication resolved symptoms and diplopia in most cases (3/5), with final near exotropia ≤8 pd in 4/5 patients.
• Transient overcorrection at distance was noted in 3 cases, resolving within 3 months.
• No overcorrection at near was observed, and no patient had persistent overcorrection at the end of follow-up.

Implications:

• Central mini-plication of medial rectus muscles offers a viable surgical option for adult convergence insufficiency with exotropia and diplopia.
• This procedure can be beneficial for patients who have not responded to or cannot tolerate non-surgical treatments.
• Further research with larger cohorts is warranted to confirm long-term efficacy and refine surgical techniques.