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

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°/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°/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.