Dose Response Analysis of Vertical Central Plication
Authors: Yi Ning J. Strube1, Kevin Cheung1, Bella R. Germano2, Wilma M. Hopman1, Kenneth W. Wright3. 1Queen's University, 2California Institute of Technology, 3Queen's University; Director and Founder Wright Foundation for Pediatric Ophthalmology and Strabismus Los Angeles CA.
Author Disclosures: Y.J. Strube: Membership on advisory boards or speakers’ bureaus; Name of for-profit or not-for-profit organization(s); Santen Canada. Membership on advisory boards or speakers’ bureaus; Description of relationship(s); Advisory Board. All other investments or relationships that could be seen by a reasonable, well-informed participant as having the potential to influence the content of the educational activity; Name of for-profit or not-for-profit organization(s); Oxford University Press Publishing, Springer Publishing, American Academy of Pediatrics. All other investments or relationships that could be seen by a reasonable, well-informed participant as having the potential to influence the content of the educational activity; Description of relationship(s); Royalty, Royalty, Royalty. K. Cheung: None. B.R. Germano: None. W.M. Hopman: None. K.W. Wright: None.
Abstract Body:
Purpose: Central plication is a minimally invasive strabismus surgery to correct small angle strabismus. The original 2012 publication described its effect mostly in horizontal strabismus. No prior study has reported on the dose response for vertical strabismus. The purpose of this study was to evaluate the surgical effect of central plication on vertical rectus muscles to correct vertical strabismus.
Study Design: Multicenter, retrospective chart review, observational outcomes study.
Methods: Data was collected from 2 strabismus surgeons working in different practice settings (2017-22). All patients who had a vertical rectus central plication were included; patients having any concurrent strabismus surgery for vertical strabismus were excluded. Primary outcome was amount of strabismus correction in prism diopters (PD) per vertical rectus central plication. Secondary outcome was to determine factors associated with better/worse surgical outcomes and patient responses to the procedure. Data was analyzed using uni- and multivariate analysis.
Results: 36 patients were included in the study. The mean patient age was 60 years (range 10 - 87 years) with mean follow-up 8 months (range 1 - 66 months). 31% had idiopathic strabismus, 19% congenital superior oblique palsy, with the remainder a mix including prior ocular surgery, trauma, and Brown syndrome. 44% had prior strabismus surgery. The inferior rectus muscle was operated on in 72% of patients. 74% of patients with diplopia pre-operatively had resolved diplopia post-operatively. 63% of patients requiring prism glasses pre-operatively no longer required prisms post-operatively. Mean vertical deviation change was 4.6 PD; sub-analysis removing patients with congenital superior oblique palsy had a slightly greater dose effect of 5.5 PD. 78% of patients had a final deviation less than or equal to 5PD. 75% of patient’s felt their diplopia was improved and/or felt better post-operatively. 1 patient required the central plication suture to be cut post-operatively for over-correction. No complications or induced post-op diplopia were reported.
Conclusions: Vertical rectus central plication corrects approximately 5 PD (range 4 - 5.5) and is an effective surgery for small angle vertical strabismus due to a variety of causes.
X
