title: Minimally invasive strabismus surgery for horizontal rectus muscle reoperations.
abstract: OBJECTIVE
  To study if minimally invasive strabismus surgery (MISS) is suitable for rectus muscle reoperations.
  
  
  METHODS
  The study presents a series of consecutive patients operated on by the same surgeon at Kantonsspital St Gallen, Switzerland with a novel MISS rectus muscle reoperation technique. Surgery is done by applying two small radial cuts along the muscle insertion. Through the tunnel obtained after muscle separation from surrounding tissue, a recession, advancement or plication is performed.
  
  
  RESULTS
  In 62 eyes of 51 patients (age 35.4 (SD 16.3) years) a total of 86 horizontal rectus muscles were reoperated. On the average, the patients had 2.1 strabismus surgeries previously. Preoperative logMAR visual acuity was 0.38 (0.82) compared with 0.37 (0.83) at 6 months (p>0.1). On the first postoperative day, in the primary gaze position conjunctival and lid swelling and redness was hardly visible in 11 eyes, discrete in 15 eyes, moderate in 11 eyes and severe in 15 eyes. One corneal dellen and one corneal erosion occurred, which both quickly resolved. The preoperative deviation at distance for esodeviations (n = 15) of 12.5 (8.5) degrees decreased to 2.6 (7.8) degrees at 6 months (p<0.001). For near, a decrease from 12.0 (10.1) degrees to 2.9 (1.6) degrees was observed (p<0.001). The preoperative deviation at distance for exodeviations (n = 35) of -16.4 (8.5) degrees decreased to -7.9 (6.5) degrees at 6 months (p<0.005). For near, a decrease from -16.5 (11.4) degrees to -2.9 (1.5) degrees was observed (p<0.005). Within the first 6 months, only one patient had a reoperation. At month 6, in four patients a reoperation was planned or suggested by us because of unsatisfactory alignment. No patient experienced persistent diplopia or necessitated a reoperation because of double vision. Stereovision improved at month 6 compared with preoperatively (p<0.01).
  
  
  CONCLUSIONS
  The study demonstrates that a small-cut, minimal dissection technique allows to perform rectus muscle reoperations. The MISS technique seems to reduce conjunctival and lid swelling in the direct postoperative period.
authors.affiliation: Department of Strabismology and Neuro-Ophthalmology, Kantonsspital, 9007 St Gallen, Switzerland. daniel.mojon@kssg.ch
authors.forename: D S
authors.initials: DS
authors.lastname: Mojon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009801:Oculomotor Muscles / Q000601:surgery*; D011182:Postoperative Care; D012029:Refraction, Ocular / Q000502:physiology; D012086:Reoperation; D013285:Strabismus / Q000601:surgery*; D013536:Suture Techniques / Q000592:standards; D013557:Switzerland; D016896:Treatment Outcome; D015348:Vision, Binocular; D014792:Visual Acuity; D055815:Young Adult
references.citation: Br J Ophthalmol. 2007 Jan;91(1):76-82
references.pmid: 17179123
references.citation: AMA Arch Ophthalmol. 1954 Jan;51(1):32-41
references.pmid: 13103883
references.citation: Graefes Arch Clin Exp Ophthalmol. 2003 Sep;241(9):699-702
references.pmid: 14658430
references.citation: J Pediatr Ophthalmol Strabismus. 1980 Mar-Apr;17(2):106-7
references.pmid: 6993650
references.citation: Am J Surg. 2005 Aug;190(2):239-43
references.pmid: 16023438
references.citation: Trans Ophthalmol Soc U K. 1986;105 ( Pt 5):583-8
references.pmid: 3467510
references.citation: Arch Ophthalmol. 1968 Jul;80(1):94-7
references.pmid: 5660023
references.citation: Br J Ophthalmol. 2007 Jan;91(1):5
references.pmid: 17179120
references.citation: Am J Ophthalmol. 1968 Jun;65(6):907-15
references.pmid: 4872139
references.citation: Ophthalmic Surg Lasers. 1998 Feb;29(2):151-6
references.pmid: 9507260
references.citation: Arch Ophthalmol. 2005 May;123(5):613-20
references.pmid: 15883279
references.citation: Br J Ophthalmol. 2005 Apr;89(4):425-9
references.pmid: 15774918
references.citation: Curr Opin Ophthalmol. 1991 Feb;2(1):16-27
references.pmid: 10149288
references.citation: Ophthalmology. 2005 May;112(5):817-24
references.pmid: 15878061
references.citation: Br J Ophthalmol. 2003 Jun;87(6):782-4
references.pmid: 12770981
references.citation: Surv Ophthalmol. 2003 Jan-Feb;48(1):73-84
references.pmid: 12559328
references.citation: Ophthalmology. 2004 Dec;111(12):2158-63
references.pmid: 15582068
references.citation: BMJ. 2002 Jan 5;324(7328):31-4
references.pmid: 11777804