Combined horizontal rectus muscle minimally invasive strabismus surgery for exotropia.

Objective: To evaluate combined horizontal rectus muscle minimally invasive strabismus surgery (MISS) for exotropia.

Design: Case series.

Participants: Fifty-two consecutive exotropic patients operated on by 1 surgeon with MISS combined unilateral lateral rectus muscle recession and medial rectus muscle plication.

Methods: Alignment, binocular single vision, conjunctival injection and swelling, and complications during the first 6 postoperative months were recorded prospectively. Conjunctival swelling and injection on the first postoperative day were scored retrospectively and compared with historic controls operated on with combined recession-plication or recession-resection using a limbal approach.

Results: Conjunctival swelling and injection were mainly mild on the first postoperative day and less pronounced than after surgery with a limbal approach (comparison of swelling and injection for MISS vs limbal opening recession-plication p < 0.001 and for MISS vs limbal opening recession-resection p < 0.001). A conversion to a limbal approach was necessary in 3/104 (3%, 95% CI 1%-7%) of all muscles. No scleral perforation or other serious complication was observed, and no patient needed a repeat operation within 6 months (0/49, 0%, 95% CI 0%-6%).

Conclusions: This study demonstrates that small-incision, minimal dissection combined recession-plication surgery induces less conjunctival swelling and injection compared with the usual limbal approach.