Reduced surgical success rate of rectus muscle plication compared to resection

Abstract

To evaluate the surgical success of rectus muscle plication compared to resection and to compare the short- and long-term changes in ocular alignment after both procedures. The medical records of all patients who underwent a rectus muscle tightening procedure (resection or plication) at a single institution over a 5-year period by a single surgeon were reviewed retrospectively. Binocular alignment was recorded before and immediately after surgery and again at 6-12weeks and final follow-up visit. Primary outcome was surgical success rate, defined as distance alignment of ≤10Δ for horizontal and ≤6Δ for vertical strabismus. Secondary outcomes were reoperation rate and postoperative alignment drift. A total of 72 surgeries were identified for inclusion: 48 resections and 24 plications. Surgical success was significantly higher in the resection group than in the plication group (89% vs 58%; P=0.005) at both 6-12weeks' follow-up (P=0.005) and at mean final follow-up of 19±13months (range, 3-56months [n=48]; P=0.03). Reoperations were performed in 3 patients in the plication group (12.5%), all for undercorrection; there were no reoperations in the resection group (P=0.03). Rectus muscle plication has many potential advantages over resection, including sparing ofthe ciliary circulation. In our experience, however, patients treated with plication hadlowersurgical success rates and a higher reoperation rate. Surgeons should monitor theirlong-term results before considering plication as their procedure of choice over resection.