Medial Rectus Inferior Half Plication for the Treatment of Near Exotropia

Abstract

Purpose: To report a relatively new surgical treatment for near exotropia called medial rectus inferior half plication. Methods: This was a retrospective analysis of the outcomes from a single surgeon performing a plication of the inferior half of the medial rectus muscle in 17 consecutive patients with near exotropia unresponsive to medial rectus bupivacaine injection. Results: Thirteen of 17 (76%) patients were asymptomatic after surgery with no diplopia for near fixation and with either a normal or slightly reduced prism fusion range enabling them to have comfortable binocular single vision. There was one minor surgical overcorrection with distance diplopia that disappeared within 2 weeks of surgery. Of the 4 of 17 (24%) patients who required further intervention, 3 required one further surgical procedure and 1 required an injection of bupivacaine into the contralateral medial rectus muscle to obtain a satisfactory alignment and control of symptoms. No patient needed more than two total operations. Conclusions: The data show medial rectus inferior plication can produce excellent outcomes with minimal risk of overcorrection. [ J Pediatr Ophthalmol Strabismus . 2024;61(3):219–222.]