Posters

Plication as an alternative to resection in horizontal strabismus: a randomized clinical trial

Poster Details

First Author: P. Sonwani INDIA

Co Author(s): A. Amitava   A. Khan   S. Gupta              

Abstract Details

Purpose:

Both resections and plications strengthen the rectus muscles, and with recessions help to achieve the surgical alignment. Despite infrequent usage, plications are less traumatic, potentially reversible, quicker, and preserve vascularity. We compared post-surgical inflammation, scarring and alignment in horizontal strabismus between resections and plications, combined with recessions: R&R or R&P groups, in a prospective, randomized masked clinical trial

Setting:

Institute of ophthalmology, AMU, Aligarh, UP, India.

Methods:

We recruited co-operative, consenting strabismic patients qualifying for the uni-ocular horizontal rectus surgeries. A detailed evaluation included VA, retinoscopy, biomicroscopy, ophthalmoscopy, strabismus measurement using prisms (PD), grading of amblyopia and assessment of ocular motility. Enrolled patients were randomized to R&R or R&P groups. Standard fixed-scleral recessions and resections were done; for plications, marked out portion of the tendons were folded on the under-surface and secured with 6-0 Polyglactin. At weeks 2 and 6 we compared the groups for inflammatory grades (Mann-Whitney), scar visibility at 1-meter and successful alignment (chi-square): defined as deviation within 10 PD.

Results:

40 patients were randomized: 22 to R&R and 18 to R&P. The groups were comparable in age [mean (SD) 18.55 (5.1) Vs 18.50 (4.4) years], strabismus-onset [4.45(3.1) Vs 4.31 (3.6) years], duration of strabismus [14.36 (5.0) Vs 13.83 (3.3) years] horizontal deviation (44.55 Vs 47.22 PD).Inflammatory scores (individual and total) for congestion, chemosis, discharge, foreign body sensation and drop intolerance compared on day 1, at 2 and 6 weeks were similar in both groups with p values > 0.05. scarring was in 16/22 Vs 9/18, p value 0.19.Success rates were: 14/22 Vs 10/18,p value 0.74.

Conclusions:

Our study shows that plication is as effective as resections, when combined with recessions, to achieve successful postoperative alignment in horizontal strabismus surgery, and given the advantages, needs to be popularized. Thus plication can be used as an alternative to resection in horizontal strabismus.

Financial Disclosure:

None