Effect of vertical central plication on vertical deviations

To evaluate the surgical effect of the Wright central plication on vertical rectus muscles to correct vertical strabismus.

In this multicenter, retrospective, observational outcomes study, data were collected from two surgeons in different practice settings (2017-22). All patients who underwent vertical rectus central plication were included; those undergoing any concurrent strabismus surgery for vertical strabismus were excluded. Primary outcome was amount of strabismus correction in prism diopters per vertical rectus central plication. Secondary outcome was to determine factors associated with better or worse surgical outcomes and patient and patient responses. Data were analyzed using descriptive and bivariate statistics.

A total of 36 patients were included. Mean age was 60 years. Mean follow-up was 8.4 months. Of the 36 patients, 11 (31%) had idiopathic strabismus, and 7 (19%) had congenital superior oblique palsy. The remainder had a history that included prior ocular surgery, trauma, and Brown syndrome; 16 (44 %) had prior strabismus surgery. Of 31 patients with preoperative diplopia, 23 (74%) had postoperative resolution of diplopia, and 10 of 16 patients with preoperative prisms (63%) no longer required prisms postoperatively. Mean vertical deviation change was 4.7^Δ. Subgroup analysis removing patients with congenital superior oblique palsy showed a larger response of 5.5^Δ. 78% of patients had a final deviation <5^Δ. No complications or induced postoperative diplopia was reported.

In our study cohort, vertical rectus central plication corrected approximately 5^Δ (range, 4.5^Δ-5.5^Δ) of vertical strabismus due to a variety of causes.