Medial rectus inferior half plication surgery for near exotropia
Reviewed by Fiona Rowe

In this study the authors report a relatively new surgical treatment for near exotropia. The study included 17 patients: four with previous surgery and all with medial rectus injection of bupivacaine to reduce the angle of deviation. Treatment involved inferior half plication of either one or both medial rectus muscles. Unilateral surgery was done if the angle at near was <12PD (n=9 cases) and bilateral surgery for greater angles of deviation (n=8). The dose was 3PD/mm of plication. Twenty procedures were performed on 17 patients: eight females and nine males. Average age at surgery was 40.1 years. Average follow-up period was 5.06 months (range 1–26). Average preoperative angle was 14.2PD (range 6–25) with average postoperative angle of 5.7PD (range -2–12). Postoperatively, 76% (n=13) were asymptomatic with no diplopia at near fixation. Four (24%) required further treatment: three surgery and one bupivacaine injection. There were no cases requiring prism use postoperatively. These results indicate medial rectus inferior plication can produce excellent outcomes, although with relatively short follow-up periods in this study. The authors acknowledge the additional limitations of the small sample size, lack of a control group and a retrospective study design. Further larger randomised controlled studies are required.

Medial rectus inferior half plication for the treatment of near exotropia.
Weatherby T, Marsh I.
JOURNAL OF PEDIATRIC OPHTHALMOLOGY AND STRABISMUS
2024;61(3):219–22.