Delta Journal of Ophthalmology · Published 2025-07-01 · DOI 10.4103/djo.djo_82_24
Background The advantages of plication, in comparison with resection, in the correction of concomitant large-angle exotropia (XT) include absence of the risk of lost muscle, reversibility in the early postoperative period, and potentially less disruption of the anterior ciliary arteries. Purpose This study was conducted to compare the efficacy, safety, and reversibility of medial rectus (MR) plication to MR resection [with bilateral lateral rectus (BLR) recession] in the correction of large-angle XT (60 prism diopters or more). Patients and methods This is a prospective, randomized comparative study that was conducted at Zagazig University Hospitals, Zagazig, Egypt. It included 40 patients having concomitant large-angle XT. The patients were classified according to the operative procedure into two groups: group 1 for whom BLR recession and unilateral MR resection was performed and group 2 for whom BLR recession and unilateral MR plication was performed. All patients were subjected to strabismus-related workup including cover tests, extraocular-muscle movement assessment, and measurement of the angle of deviation at near (33 cm) and at far (6 m) using the alternate prism cover test whenever possible and Krimsky method in sensory XT. Patch and +3 diopter lens tests were done with measurement of the deviation and XT classification. The follow-up was done at day 1, 1 week, 1, 3, and 6 months, postoperatively with measurement of ocular alignment by an alternate prism cover test for far and for near, calculation of the mean surgical dose effect, along with inflammatory scoring and operative time. Results The age of the patients ranged between 15 and 45 years with a mean of 24±8.67 years in group 1 and 23.9±8.12 years in group 2 with 50% of the patients being males. There were no significant differences between the two groups regarding the preoperative data (P>0.05). At 1 week postoperatively, the success rate in group 1 was 65% compared to 80% in group 2, with a statistically significant difference (P<0.05), while at 6 months, the success rate in group 1 was 80% compared to 75% in group 2, with no statistically significant difference (P>0.05). The operation time was significantly longer in group 1 (41.15±3.44 min) than in group 2 (36.35±4.85 min) (P=0.0007). Conclusion The plication was equivalent to resection regarding the surgical postoperative alignment with the advantage of decreasing the operative time.
Abstract from DOAJ. Public domain (CC0 1.0).
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