Surgical Outcomes Following Rectus Muscle Plication

Abstract

IMPORTANCE Extraocular muscle strengthening is a common treatment for strabismus. Plication is an alternative procedure for strengthening muscles with less tissue trauma than resection. OBJECTIVE To compare the surgical dose effect of plication with that of resection. DESIGN, SETTING, AND PARTICIPANTS Retrospective comparison of surgical outcomes in an academic pediatric ophthalmology and strabismus practice from July 25, 2005, through March 28, 2013, with a mean follow-up of 137 days for plication and 1243 days for resection. A single surgeon performed all procedures. Twenty-two consecutive patients underwent bilateral horizontal rectus plication or plication combined with antagonist recession (13 with esotropia and 9 with exotropia; mean [SD] age, 38 [21] years). Thirty-one consecutive patients underwent bilateral resection or resection combined with antagonist recession (12 with esotropia and 19 with exotropia; mean [SD] age, 28 [24] years). Six patients underwent vertical rectus plication. EXPOSURES Rectus resection or plication performed by folding the anterior tendon posteriorly under the muscle margins oversewn to the poles of the scleral insertion, avoiding the anterior ciliary arteries. MAIN OUTCOMES AND MEASURES Postoperative binocular alignment at the first postoperative and last available examinations. RESULTS Lateral rectus plication (mean [SD], 6.5 [2.2] mm) and resection (6.6 [1.6] mm) were performed for similar magnitudes of esotropia (27.9 [13.4] prism diopters [PD] for plication, 29.0 [15.2] PD for resection; P = .44). Mean (SD) initial correction by lateral rectus plication was 5.17 (0.29) PD/mm, slightly less than the 95% CI (5.51-7.75 PD/mm) for resection (6.63 [0.50] PD/mm). Medial rectus plication (mean [SD], 4.9 [0.9] mm) vs resection (5.1 [1.1] mm) was performed for similar magnitudes of exotropia (32.8 [14.2] PD for plication, 31.2 [15.6] PD for resection; P = .33). Mean (SD) initial correction by medial rectus plication (7.10 [1.65] PD/mm) was within the 95% CI (4.65-9.87 PD/mm) for resection (7.26 [1.23] PD/mm). Initial and late effects were similar. Ciliary circulation observed at surgery remained patent after plication. Plication was cosmetically acceptable and did not produce conspicuous tissue elevations. CONCLUSIONS AND RELEVANCE Horizontal rectus muscle plication is a rapidly performed, technically simple surgical procedure to strengthen the rectus muscles, with an equivalent (per millimeter) in surgical effect to that of medial rectus resection for treatment of esotropia and exotropia. Plication diminishes surgical trauma and does not intentionally sacrifice ciliary circulation, with the potential for reversal by suture release in the first postoperative days.

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

“…Surgery technique was standardised for resection, recession and plication among the surgeons, with the only difference being conjunctival incision type (para-limbal or fornix). Our technique for rectus muscle plication has been previously described 8 13. Briefly, the muscle is hooked and connective tissue bluntly dissected posteriorly.…”

Tangential Scleral Myopexy (TSM) as an Alternative to Muscle Resection in Strabismus Treatment

“…Растягивание мышцы напоминает по биомеханике истончение растягиваемого плавленого сыра. Альтернативой резекции является укорочение мышцы путем создания складки (мышечно-склеральной или мышеч-но-мышечной) [8,[10][11][12]. Эта операция представляется более физиологичной, так как щадятся передние цилиарные артерии, участвующие в питании цилиарного тела.…”

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

“…7 Plication has been shown to have a similar surgical effect per millimetre as resection for treatment of esotropia and exotropia. 8 Advantages of plication include absence of risk of lost muscle, reversibility in the early postoperative period and potentially less disruption of the anterior ciliary arteries (ACA). 9 Interest in muscle plication is increasing for these reasons, especially among those using minimally invasive techniques and topical anaesthesia.…”