Surgical techniques for reducing the conjunctival incision size in minimally invasive strabismus surgery (MISS) have been
developed (see New MISS technique is a hit) helping to drastically reduce tissue trauma and postoperative discomfort for patients.
Over the years strabismologists have used a number of access techniques for horizontal muscle recession, plication or resection.1-5
"I wanted to find a new, even less traumatic minimally invasive plication technique using no spatula, compared to the standard
MISS procedure," explained Dr Mojon. "So, rather than undertake a total dissection (TODI) I performed only a marginal dissection
(MADI) of the plicated part of the muscle."
The study
40 patients who underwent combined, horizontal MISS rectus muscle recession/MADI plication were retrospectively compared with
a group of 49 patients who had MISS recession/TODI plication. Exclusions
For those who underwent both MADI and TODI plication but who required revision surgery or retroequitorial fixation sutures,
vertical rectus muscle surgery or simultaneous surgery of an oblique muscle were excluded.
Follow-up
Orthoptic examinations were conducted postoperatively on Day 1 and after 6 months for both groups of patients. Only those
with a complication or not referred by an ophthalmologist were seen at Dr Mojon's department. The remainder were followed
up by referring ophthalmologists in between Day 10 and Week 4.
Measured outcomes
"The outcomes examined included alignment, vision variations, binocular single vision, refraction, conjunctival abnormalities,
dose-response relationship and number and types of complications experienced during the six months following the operation,"
said Dr Mojon.
The modified technique for MADI MISS
Figure 1
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A full description of this surgical technique and that for TODI MISS plications carried out by Dr Mojon is described in a
forthcoming issue of Ophthalmologica 2009 (Mojon, D.S.:Ophthalmologica 2009. A Modified Technique for Rectus Muscle Plication in Minimally Invasive Strabismus Surgery) but the following is a summary
of the steps carried out by Dr Mojon for MADI MISS plication.
- The eyeball was rolled forward away from the surgery area with a limbal traction suture
- Two small radial cuts were made for access
- Using blunt Westcott scissors a minimal dissection of the episcleral tissue around the muscle was carried out
- Two sutures were applied to the upper and lower muscle borders that will be advanced (Figure 1A)
- The sutures were then passed at the superior and inferior tendon insertions (Figures. 1B and D)
- Without the use of an iris spatula (the use of it is shown in (Figure 1C) the upper border of the muscle was plicated (Figure 1D) followed by the lower border (Figure 1E).
- Surgery was concluded by applying two sutures to each of the small incisions (Figure 1F).
