Evaluation of reinforced plication as an alternative to resection in exotropia

Abstract

Purpose: To evaluate the surgical efficacy of reinforced plication of the medial rectus muscle to resection as an effective muscle strengthening procedure in exotropia.

Methods: This is a prospective randomized trial in patients with exotropia who underwent complete orthoptic evaluation followed by random assignment into two groups by using a computer-drawn random number table. Group 1 patients underwent standard resection with recession procedure, and group 2 patients underwent reinforced plication with recession procedure. Follow-up was performed at day 1, 1 week, 1 month, 3 months, and 6 months to assess the surgical efficacy.

Results: A total of 80 patients were included in the study of which 39 were in group 1 and 41 in group 2. The mean age in group 1 was 23.48 ± 11.94 years and 23.29 ± 10.02 years in group 2. The mean preoperative deviation in group 1 for distance was 50.13 ± 11.95 PD and 50.12 ± 9.79 PD in group 2 (P = 0.499). In group 1 with a mean surgical dose of 5.27 mm medial rectus resection and 8.04 mm lateral rectus recession, a 7.11 ± 3.95 PD deviation was noted at the end of 6 months. Similarly, in group 2 with a mean surgical dose of 5.16 mm medial rectus plication and 8.16 mm lateral rectus recession, a 6.00 ± 2.46 PD deviation was noted at the end of 6 months. Between groups, ocular surface changes, inter-surgeon comparison, and exotropia subtypes did not reveal any significant differences.

Conclusion: In our observation, the reinforced medial rectus muscle plication showed clinically comparable results as compared to the standard resection procedure at the end of 6 months. Therefore, this innovative modification can be considered as an alternative to standard resection.

Keywords: Medial rectus plication; medial rectus plication versus resection for exotropia; reinforced medial rectus plication.

Figure 1

(a) After the dissection of tissue, medial rectus muscle is hooked and marked at the desired length using caliper. (b) 6-0 polyglactin sutures are passed from center to periphery in an interlocking fashion. (c) The sutures are then passed through the sclera just anterior to muscle insertion. (d) The sutures are then again passed though the muscle site to form a figure of 8. (e) An iris repositor is passed between the four sutures and the muscle. (f) With the iris repositor as a shaft, the muscle hook is now moved anteriorly to bring the muscle suture nearer to the scleral sutures to complete the plication

Figure 2

Shows the primary outcome - amount of exodrift from postoperative day 1 to 6 months. The exodrift was more in the resection group; however, no statistically significant difference was noted between them on day 1 (0.657) and 6 months (0.071) (Blue line group 1, Saffron line group 2)