title: Minimally Invasive Strabismus Surgery (MISS) Compared with the Fornix Approach in Pediatric Horizontal Strabismus Surgery.
abstract: OBJECTIVE
  To compare minimally invasive strabismus surgery (MISS) with the fornix approach in horizontal strabismus operations.
  
  
  METHODS
  We performed a retrospective study of all patients aged ≤ 12 years who underwent symmetrical surgery of the medial or lateral recti over a 1-year period. MISS was performed in one eye, and fornix opening was performed in the contralateral. We compared pre- and postoperative visual acuity (VA), conjunctival hyperemia, swelling after surgery, and operating time. The techniques were performed by 2 surgeons after a 4-year training period.
  
  
  RESULTS
  The sample comprised 16 patients, with a mean age of 6.75 ± 3.02 years. The medial rectus was operated on in 9, the lateral rectus in 7 cases. Recession was performed in 14 muscles (mean dose, 5 mm) and plication in 2 (5.5 mm and 7 mm, respectively). MISS was performed in 12 right eyes and 4 left eyes. Preoperative VA was 0.77 in MISS and 0.80 in the control group. VA was 0.83 in MISS and 0.76 in the control group 1 day after surgery. No significant differences were found for conjunctival hyperemia between the MISS and fornix groups 1 day or 1 week after surgery. Nevertheless, moderate/severe conjunctival hyperemia was less frequent in the MISS group (31.3% versus 62.5%). No significant differences were found for operating time (14.43 minutes [MISS] vs 12.37 minutes [control]).
  
  
  CONCLUSIONS
  The MISS technique was similar to the fornix approach in the early postoperative period with respect to VA, conjunctival inflammation, and operating time in pediatric horizontal strabismus surgery.
authors.affiliation: a Ocular Motility Section, Department of Ophthalmology , Hospital General Universitario Gregorio Marañón , Madrid , Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Merino Sanz
authors.affiliation: a Ocular Motility Section, Department of Ophthalmology , Hospital General Universitario Gregorio Marañón , Madrid , Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Gómez de Liaño Sánchez
authors.affiliation: a Ocular Motility Section, Department of Ophthalmology , Hospital General Universitario Gregorio Marañón , Madrid , Spain.
authors.forename: Irene Blanco
authors.initials: IB
authors.lastname: Domínguez
mesh_terms: D002648:Child; D002675:Child, Preschool; D003867:Depth Perception / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D009801:Oculomotor Muscles / Q000503:physiopathology / Q000601:surgery*; D061646:Operative Time; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*; D011184:Postoperative Period; D012189:Retrospective Studies; D013285:Strabismus / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D015348:Vision, Binocular / Q000502:physiology*; D014792:Visual Acuity / Q000502:physiology
keywords: Fornix approach; horizontal strabismus; inflammation; minimally invasive strabismus surgery; surgical time