Paper 24

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Plication Versus Resection: A Qualitative and Quantitative Comparison

 Jaspreet Sukhija, MD; Savleen Kaur, MD
Post Graduate Institute of Medical Education and research
Chandigarh,India

Introduction:  Plication of the recti is a well described tightening but sparingly used procedure. Resection on the other hand is the routinely performed strengthening surgery.The efficacy of plication to resection is limited by paucity of literature and has never been documented on imaging. This series attempts to compare the two techniques in exotropia   along with quantitative assessment on Ultrasound Biomicrocope (UBM).

Methods:  Patients with exotropia between 30-50 PD who had undergone first time horizontal strabismus surgery were recruited and  and underwent UBM evaluation 1 year after surgery. Plication was performed by folding the anterior part of medial rectus muscle posteriorly and then tying it at the insertion to the sclera. Resection was done in a routine manner.Only patients with basic comitant exotropia without any vertical pattern were included.

Results:  15 patients underwent a resection of the medial rectus and 13 patients underwent plication during the study period. The two groups were age and deviation matched preoperatively. The patients undergoing plication and resection fared equally in terms of postoperative deviation (p=0.81) and abduction limitation (p=0.169).  UBM could identify and quantify plication in all cases with excellent agreement to the operative data (Intraclass correlation coefficient=0.886; p=0.000).

Discussion:  Medial rectus plication or resection performed for similar angles of exotropia produced quantitatively similar effects. Plication offered an added advantage of being characteristically identifiable and measurable on UBM

Conclusion:  In those requiring additional surgery later one can measure the weakening and strengthening performed earlier to decide the next intervention with a fair amount of accuracy.

References:  1.Chaudhuri Z, Demer JL. Surgical outcomes following rectus muscle plication: a potentially reversible, vessel-sparing alternative to resection. JAMA Ophthalmol 2014;132:579-85.
2.Thakur N, Singh R, Kaur S et al. Ultrasound Biomicroscopy in Strabismus Surgery: Efficacy in Postoperative Assessment of Horizontal Muscle Insertions. Strabismus 2015;23:73-9.
3.Kimura Y, Kimura T. Comparitive study of Plication-recession versus resection-recession in unilateral surgery for intermittent exotropia. Jpn J Ophthalmol 2017;61:286-291
4.Alkharashi M, Hunter DG. Reduced surgical success rate of rectus muscle plication compared to resection J AAPOS 2017;21:201-204

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