Fornix Incision Versus Minimally Invasive Strabismus Surgery (MISS) Approaches to Strabismus Surgery, An Effectiveness Study
Simon Westby; Saurabh Jain; Naomi Tan
Royal Free Hospital
Introduction: To compare the effectiveness and patient acceptance of Fornix incision versus Minimally Invasive Strabismus Surgery (MISS) approaches.
Methods: Over a 9 month period we looked at patients undergoing horizontal squint surgery to assess whether surgical outcome and patient satisfaction is dependent on surgical incision type. We assessed the effectiveness of surgery as well as the pre and post-operative quality of life using the AS20 score. We asked patients to rate their discomfort subjectively post-operatively and compared pre and post-surgical strabismus measurements and complications.
Results: In this period 14 patients met our inclusion criteria. The fornix patients (mean age 38, range 21-66) underwent a recess-resect procedure whereas the MISS patients (mean age 36, range 15-76) underwent a recess-plication. The effectiveness of the surgical procedure was 2.56D/mm for near and 2.89D/mm for distance in the fornix incision group and 1.76D/mm for near and 1.83D/mm for distance) in the MISS group. There was no clear effect of surgical incision type on patient satisfaction as assessed by subjectively reported post-operative comfort and AS20 scores.
Discussion: These results suggest that the distance muscles are moved may be overestimated through MISS incisions. There is no clear forerunner in terms of patient comfort.
Conclusion: Further research is needed to confirm the difference in effectiveness between the fornix incision technique and MISS and to investigate potential causes. A lack of significant difference in any of the patient comfort and perception markers suggests incision type may be best allocated based on patient and surgical factors on a case-by-case basis
References: 1) Amitava A, Bani S, Sharma R. Minimally invasive strabismus surgery versus paralimbal approach: A randomized, parallel design study is minimally invasive strabismus surgery worth the effort?. Indian Journal of Ophthalmology. 2014;62(4):508.
2) Mojon D. Review: minimally invasive strabismus surgery. Eye. 2014;29(2):225-233. doi:10.1038/eye.2014.281.
3) Tan N, Jolly R, Jain S. Fornix-Based Incision for Strabismus Surgery: The Parks Technique Revisited. Journal of Pediatric Ophthalmology & Strabismus. 2011