Evaluation of Surgical Efficacy of Plication Versus Resection of Medial Rectus in Intermittent Exotropia
Pradeep I. Sharma, MD, FAMS; Hameed Obedulla, MD
R P Center for Ophthalmic Sciences, AIIMS
New Delhi, India
Introduction: To evaluate the surgical efficacy of plication of medial rectus muscle in comparison to resection as an effective muscle strengthening procedure
Methods: A prospective interventional study in 20 patients of intermittent exotropia, 10 patients underwent MR plication (group 1) and other 10 underwent MR resection (group 2) along with LR recession in both the groups. A reinforcement suture used to prevent late under-correction. A minimal follow-up of 3 months kept.
Results: Mean preoperative deviation in group 1 was 44.1±10.17 and 47.5±10.7 in group 2 with a p-value of 0.488. The amount of surgical correction done was 4.8mm ±0.82 of MR plication, 7.75±0.97 of LR recession for group 1 and 5.15mm ±0.57 of MR resection, 8.05mm±0.64 of LR recession in group 2. The mean postoperative deviation at the end of 3 months was 7.7pd ±6.6 in group 1 and 7.6pd ±2.79 in group 2. Both plication and resection group produced similar results (pvalue 0.42).
Discussion: Per mm effectivity of Plication(4.58mm) vs resection(4.6)was seen.One patient had a consecutive esotropia of 25pd on the first postop day which was corrected simply by release of plication, thereby making this procedure effectively reversible. This is a major advantage.
Conclusion: Plication can be effectively used as an alternative to resection in routine horizontal rectus muscle surgery with the added advantage of being partly reversible in early postoperative phase.
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