Paper 23

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Resection Versus Plication for the Management of Exotropia

Twinkle Mehta; Phoebe Lenhart, MD; Amy Hutchinson, MD; Jason Peragallo, MD
Emory University
Atlanta, GA

Introduction: Resection and plication can both be used to tighten extraocular muscles. The purpose of our study was to determine whether motor outcomes and stereopsis are equivalent for resection verses plication in management of exotropia.

Methods: We reviewed the medical records of 138 consecutive pediatric and adult patients who underwent lateral rectus recession paired with either medial rectus resection (N=62) or plication (N=76) for exotropia between May 2012 and May 2016. Patients with a history of prior strabismus surgery or a restrictive process were excluded. Motor success was defined as 10 PD or less of residual exotropia or 4 PD or less of consecutive esotropia. Outcomes were measured using a t-test for continuous variables and chi-square test for categorical variables. Statistical significance was defined as two-tailed p < 0.05.

Results: There was no difference in motor success at last follow up (52% plication; 48% of resection p=0.61; N= 138). The mean follow up time was 13.7 months with a standard deviation of 15.7 months. There was no difference in the percentage of patients not undergoing reoperation (92% plication; 95% of resection p=0.77; N= 138). There was no difference in final mean stereoacuity (plication 626.5 sec arc, resection 597.4 sec arc p=0.93).

Discussion: We found no difference in motor success or stereopsis for resection vs. plication at last clinic visit. Plication might offer the advantage of being a less traumatic procedure and might spare the anterior circulation.

Conclusions: Plication and resection appear to be equally effective for treatment of exotropia.

References:

  1. Chaudhuri Z, Demer JL. Surgical outcomes following rectus muscle plication: a potentially reversible, vessel-sparing alternative to resection. JAMA Ophthalmol. 2014 May;132(5):579-85. PMID: 24676145
  2. Oltra EZ, Pineles SL, Demer JL, Quan AV, Velez FG. The effect of rectus muscle recession, resection and plication on anterior segment circulation in humans. Br J Ophthalmol. 2015 Apr;99(4):556-60. PMID: 25342275
  3. Wright KW. Rectus muscle plication JAMA Ophthalmol. 2015 Feb;133(2):226-7. PMID: 25357136
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