title: Combined horizontal rectus muscle minimally invasive strabismus surgery for exotropia.
abstract: OBJECTIVE
  To evaluate combined horizontal rectus muscle minimally invasive strabismus surgery (MISS) for exotropia.
  
  
  METHODS
  Case series.
  
  
  METHODS
  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.
authors.affiliation: Department of Strabismology and Neuro-Ophthalmology, Kantonsspital, St. Gallen, Switzerland.
authors.forename: Niccolò
authors.initials: N
authors.lastname: Pellanda
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Mojon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005099:Exotropia / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009801:Oculomotor Muscles / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures; D015348:Vision, Binocular / Q000502:physiology; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult