Surgical outcomes following rectus muscle plication versus resection combined with antagonist muscle recession for basic horizontal strabismus

Abstract

Purpose: To evaluate change in ocular alignment and surgical success of rectus muscle plication versus resection when coupled with antagonist muscle recession for basic esodeviations and exodeviations.

Methods: The medical records of consecutive patients with basic horizontal strabismus who underwent a rectus muscle plication or resection combined with a known amount of antagonist muscle recession from January 2009-June 2016 by one surgeon were reviewed retrospectively. Changes in ocular alignment and surgical success at 4-16 weeks after surgery and reoperation rates for plication compared to resection were assessed. Success was defined as undercorrection of ≤10^Δ and overcorrection of ≤4^Δ at distance.

Results: A total of 162 patients with basic esotropia (88 lateral rectus muscle plications; 74 lateral rectus resections) and 60 patients with basic exotropia (31 medial rectus muscle plications; 29 medial rectus resections) were included. Success rates at 4-16 weeks after surgery were 95.5% for lateral rectus plication, 89.2% for lateral rectus resection, 77.4% for medial rectus plication, and 96.6% for medial rectus resection. No significant differences were found when analyzing the change in ocular alignment between the plication and resection groups for patients with either basic esotropia or basic exotropia. Reoperation rates were low for all groups (range, 3.2%-5.4%) during a follow-up period of 4 weeks to 72 months.

Conclusions: Horizontal rectus muscle plication produced similar changes in ocular alignment and surgical success compared to rectus muscle resection at 4-16 weeks after surgery when coupled with comparable amounts of antagonist muscle recession.