Rectus Muscle Plication Research Articles

Three horizontal muscle surgery for infantile esotropia and decompensated microtropia

Surgical management of large-angle infantile esotropia and decompensated microtropia has been controversially debated. There seems to be a relative bias against surgery on more than two horizontal muscles to avoid overcorrections. In our study we report on the sensory and motor outcomes after three horizontal muscle surgery. Furthermore we aim to suggest a table to guide surgery amounts. This study was a retrospective interventional cohort of 27 patients (16 female, 11 male; mean age 7.9 [years], ranging from 1 to 27 [years]) with infantile esotropia and decompensated microtropia who underwent three horizontal muscle surgery (bilateral medial rectus muscle recession and lateral rectus muscle plication) between 2005 and 2013. Preoperative deviation in primary position measured 30.2 [°] (mean; range 21.9 to 48.0). Postoperatively esotropia was significantly reduced to 2.6 [°] (mean; range -16.7 to 16.7). After six months deviation measured 5.5 [°] (mean, range -14.1 to 21.9). An effect of 1.63°/mm was calculated for the combined three muscle surgery. For the correction of large-angle infantile esotropia and decompensated microtropia three horizontal muscle surgery is associated with a high success rate. Only a very low rate of consecutive exotropia does occur.

The effect of rectus muscle recession, resection and plication on anterior segment circulation in humans

BackgroundPlication is an alternative tightening procedure to resection. In monkeys, plication has been shown to preserve anterior segment circulation compared with full-tendon tenotomy, but this is unconfirmed in humans.PurposeTo evaluate...

The effect of rectus muscle recession, resection and plication on anterior segment circulation in humans

Anterior segment (AS) ischemia is a rare but serious complication of strabismus surgery. In animals, rectus muscle plication disrupts AS circulation less than resection, but this is unconfirmed in humans. This study aimed to evaluate AS circulation after strabismus surgery in humans.

Surgical Outcomes Following Rectus Muscle Plication

Extraocular muscle strengthening is a common treatment for strabismus. Plication is an alternative procedure for strengthening muscles with less tissue trauma than resection. To compare the surgical dose effect of plication with that of resection. Retrospective comparison of surgical outcomes in an academic pediatric ophthalmology and strabismus practice from July 25, 2005, through March 28, 2013, with a mean follow-up of 137 days for plication and 1243 days for resection. A single surgeon performed all procedures. Twenty-two consecutive patients underwent bilateral horizontal rectus plication or plication combined with antagonist recession (13 with esotropia and 9 with exotropia; mean [SD] age, 38 [21] years). Thirty-one consecutive patients underwent bilateral resection or resection combined with antagonist recession (12 with esotropia and 19 with exotropia; mean [SD] age, 28 [24] years). Six patients underwent vertical rectus plication. Rectus resection or plication performed by folding the anterior tendon posteriorly under the muscle margins oversewn to the poles of the scleral insertion, avoiding the anterior ciliary arteries. Postoperative binocular alignment at the first postoperative and last available examinations. Lateral rectus plication (mean [SD], 6.5 [2.2] mm) and resection (6.6 [1.6] mm) were performed for similar magnitudes of esotropia (27.9 [13.4] prism diopters [PD] for plication, 29.0 [15.2] PD for resection; P = .44). Mean (SD) initial correction by lateral rectus plication was 5.17 (0.29) PD/mm, slightly less than the 95% CI (5.51-7.75 PD/mm) for resection (6.63 [0.50] PD/mm). Medial rectus plication (mean [SD], 4.9 [0.9] mm) vs resection (5.1 [1.1] mm) was performed for similar magnitudes of exotropia (32.8 [14.2] PD for plication, 31.2 [15.6] PD for resection; P = .33). Mean (SD) initial correction by medial rectus plication (7.10 [1.65] PD/mm) was within the 95% CI (4.65-9.87 PD/mm) for resection (7.26 [1.23] PD/mm). Initial and late effects were similar. Ciliary circulation observed at surgery remained patent after plication. Plication was cosmetically acceptable and did not produce conspicuous tissue elevations. Horizontal rectus muscle plication is a rapidly performed, technically simple surgical procedure to strengthen the rectus muscles, with an equivalent (per millimeter) in surgical effect to that of medial rectus resection for treatment of esotropia and exotropia. Plication diminishes surgical trauma and does not intentionally sacrifice ciliary circulation, with the potential for reversal by suture release in the first postoperative days.

Rectus muscle plication using an adjustable suture technique

Rectus muscle plication is an alternative muscle-strengthening procedure to rectus muscle resection. Possible advantages of rectus muscle plication include a lower risk of "lost" muscles and anterior segment ischemia.This was a retrospective case series describing a surgical procedure for rectus muscle plication using an adjustable suture technique that can be used on any of the four rectus muscles.A total of 5 adult patients underwent adjustable suture plication procedures. Of these, 2 patients required suture adjustment postoperatively. At the final follow-up visit, all the patients maintained satisfactory ocular alignment within 6(Δ) of orthotropia for horizontal deviations and 2(Δ) of orthotropia for vertical deviations. Diplopia was eliminated in all cases with preoperative diplopia. There were no postoperative complications or unexpected shifts in ocular alignment.Rectus muscle plication using this adjustable suture technique may serve as an alternative to rectus muscle resection and may be particularly useful in patients who are at risk for anterior segment ischemia or those in whom a shorter anesthesia time is recommended.

Closure of midline contaminated and recurrent incisional hernias with components separation technique reinforced with plication of the rectus muscles

Midline incisional hernia reconstruction by defect closure and reinforcement with either prosthetic or biologic materials has shown to significantly decrease recurrence rates even for complex cases. The purpose of this study is to evaluate outcomes regarding large incisional hernia reconstruction with components separation technique using rectus muscle plication as a reinforcement method. Thirteen patients having large midline incisional hernias and either history of abdominal wall contamination or recurrence in the presence of mesh were treated between January 2007 and December 2011 with closure using components separation technique reinforced by rectus muscle plication. Average hernia square was 222 cm(2), and mean follow-up was 24 months. Complications occurred in 6 patients with a mean time to resolution of 59 days. One recurrence was present. When use of mesh or biologic materials is not desired, rectus muscle plication is a feasible tool as a reinforcement method after large hernia closure with components separation.

Abdominoplastia com lipoaspiração e descolamento mínimo

O autor descreve sua metodologia, em abdominoplastia associada a lipoaspiracao, utilizando os principios de manutencao da vascularizacao e da drenagem linfatica do abdome. Introduz uma modificacao na preservacao do sistema vascular, mantendo dois triângulos de fascia superficial lateral e a resseccao do segmento medial infraumbilical, que permite uma plicatura ampla e adequada da fascia muscular abdominal, bem como uma pubectomia parcial (PP). Esta modificacao tem sido importante para a obtencao de resultados esteticos semelhantes aqueles conseguidos com a tecnica classica, acrescidos do beneficio de uma lipoaspiracao ampla, em toda a extensao do abdome e flancos, melhorando o resultado final, e reduzindo a incidencia de complicacoes.

Combined horizontal rectus muscle minimally invasive strabismus surgery for exotropia

Objective: To evaluate combined horizontal rectus muscle minimally invasive strabismus surgery (MISS) for exotropia. Design: Case series. Participants: Fifty-two consecutive exotropic patients operated on by 1 surgeon with MISS combined unilateral lateral rectus muscle recession and medial rectus muscle plication. Methods: Alignment, binocular single vision, conjunctival injection and swelling, and complications during the first 6 postoperative months were recorded prospectively. Conjunctival swelling and injection on the first postoperative day were scored retrospectively and compared with historic controls operated on with combined recession-plication or recession-resection using a limbal approach. Results: Conjunctival swelling and injection were mainly mild on the first postoperative day and less pronounced than after surgery with a limbal approach (comparison of swelling and injection for MISS vs limbal opening recession-plication p < 0.001 and for MISS vs limbal opening recession-resection p < 0.001). A conversion to a limbal approach was necessary in 3/104 (3%, 95% CI 1%–7%) of all muscles. No scleral perforation or other serious complication was observed, and no patient needed a repeat operation within 6 months (0/49, 0%, 95% CI 0%–6%). Conclusions: This study demonstrates that small-incision, minimal dissection combined recession-plication surgery induces less conjunctival swelling and injection compared with the usual limbal approach.

A Modified Technique for Rectus Muscle Plication in Minimally Invasive Strabismus Surgery

Purpose: To present a novel, minimally invasive strabismus surgery (MISS) technique for faster and less invasive rectus muscle plication. Methods: The new plication method is performed without spatula and, therefore, instead of a total dissection (TODI) only a marginal dissection (MADI) of the plicated part of the muscle is performed. Forty patients operated with combined, horizontal MISS rectus muscle recession/MADI plication are retrospectively compared to a similar group of 49 patients, who had MISS recession/TODI plication. The following outcome parameters were analyzed: alignment, binocular single vision, variations in vision, refraction, conjunctival abnormalities, dose-response relationship, and number and types of complications during the first 6 postoperative months. Results: Postoperatively, the conjunctiva over the plicated muscle was less swollen and red with MADI compared to TODI plication (p < 0.01). In esodeviations, there was no significant difference in the dose-response relationship between MADI and TODI plication (1.38 ± 0.44 vs. 1.44 ± 0.50°/mm, p > 0.1). In exodeviations, the difference between MADI and TODI plications was not significant either (1.41 ± 0.38 vs. 1.42 ± 0.50°/mm, p > 0.1). Also final alignment, binocular single vision, visual acuities, refractive changes, or complications did not differ between the two techniques. Conclusions: This study demonstrates that MADI plication is feasible and equally effective in comparison with the TODI plication technique when performing MISS. MADI plication, which is performed without spatula, allows to considerably further reduce postoperative conjunctival swelling and redness.

Minimally Invasive Strabismus Surgery Technique in Horizontal Rectus Muscle Surgery for Esotropia

Purpose: To evaluate the minimally invasive strabismus surgery (MISS) technique in combined unilateral horizontal rectus muscle operations for esotropia. Methods: This study included 61 patients operated by one surgeon with MISS medial rectus muscle recession and lateral rectus muscle plication. Alignment, binocular vision, conjunctival injection and swelling as well as complications during the first 6 postoperative months were recorded prospectively. Conjunctival swelling and injection on postoperative day 1 were scored retrospectively and compared to a study, which included patients operated with a limbal approach. Results: Conjunctival swelling and injection were less pronounced than following surgery with limbal approach (comparison of swelling and injection: p < 0.001 for MISS vs. limbal opening plication and p < 0.001 for MISS vs. limbal opening resection). A conversion to a limbal opening was necessary in 2.4% of muscles. No scleral perforation or other serious complication was observed. Conclusions: This study indicates that MISS induces less conjunctival swelling and injection compared to the usual limbal approach.

Minimally invasive strabismus surgery

In 2007, I published in the British Journal of Ophthalmology a new, minimally invasive access technique for primary horizontal rectus muscle recession and plication and its results.1 I suggested performing...

Superior Oblique Tendon Incarceration Syndrome

To describe the clinical features, etiology, and management of superior oblique tendon incarceration syndrome. This series consists of all patients I treated between September 15, 1974, and March 1, 2006, for restrictive hypertropia in which the superior oblique tendon was found scarred to the superior rectus muscle insertion after prior surgery. Twenty eyes in 18 patients were included in this series. The mean+/-SD hypertropia of the affected eye was 15.4+/-9.0 prism diopters, and the mean+/-SD incyclotropia was 15.0 degrees+/-3.5 degrees. Causes of superior oblique tendon incarceration syndrome included prior superior rectus muscle resection, recession, plication, or transposition; superior oblique tendon recession, disinsertion, or posterior tenectomy; and scleral buckling surgery. The syndrome was difficult to treat and required a mean+/-SD of 1.9+/-0.7 additional surgical procedures to correct. Superior oblique tendon incarceration syndrome is a complication of surgery on the superior rectus muscle or superior oblique tendon that can result in restrictive hypertropia and incyclotropia. Proper handling of the connection between the superior oblique tendon and superior rectus muscle at the time of surgery may prevent this complication, which can be difficult to treat.