Minimally Invasive Strabismus Surgery Technique in Horizontal Rectus Muscle Surgery for Esotropia

Abstract

Purpose: To evaluate the minimally invasive strabismus surgery (MISS) technique in combined unilateral horizontal rectus muscle operations for esotropia. Methods: This study included 61 patients operated by one surgeon with MISS medial rectus muscle recession and lateral rectus muscle plication. Alignment, binocular vision, conjunctival injection and swelling as well as complications during the first 6 postoperative months were recorded prospectively. Conjunctival swelling and injection on postoperative day 1 were scored retrospectively and compared to a study, which included patients operated with a limbal approach. Results: Conjunctival swelling and injection were less pronounced than following surgery with limbal approach (comparison of swelling and injection: p < 0.001 for MISS vs. limbal opening plication and p < 0.001 for MISS vs. limbal opening resection). A conversion to a limbal opening was necessary in 2.4% of muscles. No scleral perforation or other serious complication was observed. Conclusions: This study indicates that MISS induces less conjunctival swelling and injection compared to the usual limbal approach.

A Modified Technique for Rectus Muscle Plication in Minimally Invasive Strabismus Surgery

“…Keyhole openings can also be used for graded inferior oblique surgery [10], rectus muscle transpositions [11] and retroequatorial rectus muscle fixation sutures [12]. A newer study confirms that MISS reduces tissue traumatism compared to a large conjunctival opening in horizontal rectus muscle surgery [13]. In this study, a new, less traumatic minimally invasive plication (tuck) technique using no spatula is presented and compared to the usual MISS plication technique.…”

Intraoperative conversion rate to a large, limbal opening in minimally invasive strabismus surgery (MISS)

“…We found no influence of restricted ocular motility and the amount of surgery on the conversion rate. One simple explanation could be that, in such cases, the size of the openings is primarily larger, and therefore, visualisation is no worse than in other cases [7][8][9][10][11][12][13][14].…”

“…For strabismus surgery minimizing tissue disruption, the term minimally invasive strabismus surgery (MISS) has been proposed [7][8][9][10][11][12][13][14]. For rectus muscle loop recession, Gobin and Bierlaagh described the principle of access through two small radial openings, one along the superior and the other along the inferior margin of the horizontal rectus muscles [15].…”

A Review of Minimally Invasive Strabismus Surgery (MISS): Is This the Way Forward?

“…In younger patients, excessive Tenon's capsule hinders the surgical approach to muscles, while in patients over 40 years of age poor conjunctival elasticity can lead to tears and the subsequent enlargement of microincisions. Overall, MISS can be employed in all types of strabismus surgeries, namely rectus muscle recessions, resections, plications, reoperations, retroequatorial myopexy, transpositions, oblique muscle recessions or plications, and adjustable sutures even in the presence of restricted motility [8,[15][16][17][18][19][20][21].…”