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Melinda Chang, Stacy Pineles, Federico Velez; Minimally invasive adjustable suture marginal tenotomy and plication for correction of incomitant vertical strabismus and torsion. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5226.
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To evaluate the effectiveness of minimally invasive adjustable suture marginal tenotomy and plication of vertical rectus muscles in correcting incomitant vertical strabismus and torsion.
Retrospective review of all patients who underwent marginal tenotomy or marginal plication of a vertical rectus muscle for correction of incomitant vertical strabismus or torsion by a single surgeon at a single Eye Institute from July 2013 to September 2014. Patients were excluded if they did not complete at least 6 weeks of follow-up.
A total of 10 patients were identified. Two patients underwent monitored anesthesia care, and eight patients had general anesthesia. Marginal plications were performed on five patients, two of whom had incomitant vertical strabismus, one of whom had cyclotorsion without incomitant vertical strabismus, and two of whom had both. Marginal tenotomies were performed on five patients to correct both incomitant vertical strabismus and cyclotorsion. Two patients were adjusted postoperatively. Marginal plications corrected a mean of 10 prism diopters (range 4 to 14 prism diopters) of incomitant deviation, from a mean of 10.75 prism diopters (range 4 to 14 prism diopters) preoperatively. Marginal plications corrected a mean of 2 degrees of cyclotorsion (range 4 degrees increase in torsion to 8 degrees decrease in torsion), from a mean preoperative torsion of 8 degrees (range 11 degrees incyclotorsion to 8 degrees excyclotorsion). Marginal tenotomies corrected a mean of 4.7 prism diopters (range 2 to 9 prism diopters) of vertical incomitance, from a mean of 5 prism diopters (range 2 to 9 prism diopters) preoperatively. Marginal tenotomies corrected a mean of 3.7 degrees of cyclotorsion (range 0.5 degrees increase in torsion to 9 degrees decrease in torsion) from a mean preoperative torsion of 7.3 degrees (range 5 to 10 degrees excyclotorsion). Nine of 10 patients had resolution of vertical and torsional diplopia postoperatively.
Minimally invasive marginal tenotomy and marginal plication surgeries are effective in reducing or eliminating incomitant vertical strabismus. Their effect on torsion is more variable. They are advantageous compared to surgery on oblique muscles, especially the inferior oblique, because they can be performed under monitored anesthesia care with intraoperative and/or postoperative adjustment.
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