title: Surgical outcomes following rectus muscle plication: a potentially reversible, vessel-sparing alternative to resection.
abstract: OBJECTIVE
  Extraocular muscle strengthening is a common treatment for strabismus. Plication is an alternative procedure for strengthening muscles with less tissue trauma than resection.
  
  
  OBJECTIVE
  To compare the surgical dose effect of plication with that of resection.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  Postoperative binocular alignment at the first postoperative and last available examinations.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: SteinEye Institute, University of California, Los Angeles2Department of Ophthalmology, University of California, Los Angeles.
authors.forename: Zia
authors.initials: Z
authors.lastname: Chaudhuri
authors.affiliation: SteinEye Institute, University of California, Los Angeles2Department of Ophthalmology, University of California, Los Angeles3Department of Neurology, University of California, Los Angeles4Neuroscience Interdepartmental Program, University of California, L.
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Demer
mesh_terms: D000328:Adult; D004948:Esotropia / Q000503:physiopathology / Q000601:surgery*; D005099:Exotropia / Q000503:physiopathology / Q000601:surgery*; D005133:Eye Movements / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009801:Oculomotor Muscles / Q000503:physiopathology / Q000601:surgery*; D017060:Patient Satisfaction; D011184:Postoperative Period; D012189:Retrospective Studies; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome; D015348:Vision, Binocular / Q000502:physiology*