Surgical outcomes of Scott 2:1 recession-resection adjustable technique for incomitant strabismus.

Comparative surgical outcomes of rectus muscle plication versus resection in horizontal strabismus correction: a systematic review.

PURPOSE Rectus muscle resection is a standard strengthening procedure in horizontal strabismus surgery, but it requires muscle disinsertion and tissue excision. Rectus muscle plication has been proposed as a vessel-sparing alternative that preserves the muscle insertion and may reduce selected technical risks. This review evaluates the comparative effectiveness, safety, and short- to medium-term outcomes of plication versus resection in horizontal strabismus surgery. METHODS This systematic review was conducted according to PRISMA guidelines and registered in PROSPERO. MEDLINE, CENTRAL, Google Scholar, and Web of Science were searched for comparative studies published through January 2025. Eligible studies directly compared rectus muscle plication with resection for horizontal strabismus. Risk of bias was assessed using RoB 2 for randomised trials and the Newcastle-Ottawa Scale for non-randomised studies. RESULTS Fifteen studies were included, comprising six randomised controlled trials and nine non-randomised comparative studies. Overall, 501 patients underwent plication and 576 underwent resection. Both procedures produced clinically meaningful improvement in ocular alignment, with most studies reporting final residual deviations within or near 10 prism dioptres. Across studies reporting formal success rates, plication success ranged from 27.8% to 100% and resection success from 55.3% to 100%; however, success definitions varied substantially, limiting direct comparison. Most studies found no statistically significant difference between procedures. Early overcorrection and postoperative diplopia were lower with plication in some studies. Complications were generally mild. No anterior segment ischaemia was reported, and no slipped or lost muscles were reported in any plication group. Conjunctival swelling or muscle hump after plication was transient and self-resolving. CONCLUSION Rectus muscle plication appears to be a safe and effective alternative to resection for horizontal strabismus, with broadly comparable short- and medium-term alignment outcomes. Plication offers technical advantages, including preservation of anterior ciliary circulation and avoidance of muscle disinsertion, but evidence for long-term durability remains less certain, especially in paediatric intermittent exotropia. Future studies should use standardised success definitions, stratify outcomes by strabismus subtype and age group, and include longer follow-up. Registration: PROSPERO [CRD42024560726].

Combined Orbital Decompression and Rectus Muscle Myectomy for Large-Angle Strabismus in Thyroid-Associated Orbitopathy.

INTRODUCTION Thyroid-associated orbitopathy (TAO) often causes restrictive strabismus and diplopia. Large-angle deviations pose particular challenges owing to extraocular muscle fibrosis and unpredictable surgical dose-response. Although combined orbital decompression and strabismus correction has been proposed to reduce the number of procedures, its effectiveness in large-angle TAO remains uncertain. This study aimed to evaluate the outcomes of combined orbital decompression and rectus muscle myectomy in this population. METHODS In this retrospective cohort study, 88 patients with TAO-associated strabismus > 25 prism diopters (PD) underwent either staged (step) surgery (n = 42) or combined surgery (n = 46) at a tertiary center between 2018 and 2022. All had stable thyroid function for ≥ 6 months before surgery. The combined procedure involved simultaneous orbital decompression and rectus myectomy. Outcomes included deviation angles, Hertel exophthalmometry, and the field of binocular single vision (BSV). RESULTS Baseline characteristics were comparable between groups. Postoperatively, the combined-surgery group had smaller residual horizontal and vertical deviations-median 0 (0-3) and 2 (0-3) PD-than the step group, 5 (4-5) and 3 (3-5) PD (all p < 0.001). The BSV field was wider after combined surgery [410 (396-426)° versus 360 (328-386)°, p < 0.001]. Overall success rates (≤ 5 PD deviation in primary and reading positions) were similar (84.8% versus 81.0%, p = 0.633). Transient lower lid retraction occurred in a few patients and was successfully corrected. CONCLUSIONS Combined orbital decompression with rectus myectomy achieved effective alignment and superior binocular function compared with staged surgery, offering a practical and safe option for TAO-related large-angle strabismus.

Revision plan and results of anterior and posterior ptosis surgery.

PURPOSE To assess the outcomes of revision ptosis surgeries performed using a surgical technique different from the initial procedure-either Müller muscle conjunctival resection (MMCR) or external levator surgery (ELS) based on the phenylephrine-induced change in margin reflex distance-1 (MRD-1). METHODS This retrospective cohort study reviewed medical records of 780 patients who underwent MMCR or ELS for ptosis between January 2019 and December 2023. Revision surgery was required in 108 patients (15%). Among these, 32 eyes of 28 patients underwent a revision surgery using a technique different from the initial approach. Patient demographics, surgical details, and MRD-1 values at key clinical stages (pre-primary surgery, post-primary surgery, pre-revision surgery, and post-revision surgery) were recorded, along with levator function and postoperative complications. RESULTS Twenty-eight patients (11 female, 17 male) were included. ELS was performed as the initial procedure in 13 eyes, and MMCR in 19 eyes. Surgical method for revision was determined based on the pre-revision phenylephrine response. Patients who initially underwent MMCR were classified as Group 1; those with initial ELS as Group 2. The mean interval between surgeries was 33.3 ± 38.2 months, and the mean follow-up duration was 42.5 ± 22.9 months. No significant difference in levator function or baseline MRD-1 values was observed between groups. A significant improvement in MRD-1 was noted after both primary and revision surgeries in each group. Eyelid symmetry was achieved in all patients. CONCLUSION Satisfactory functional and cosmetic outcomes can be obtained in revision ptosis surgery using an alternative technique to the primary approach. Preoperative phenylephrine testing and comprehensive patient evaluation are critical for surgical planning.

Beyond the incision: Does release extent matter in congenital muscular torticollis? A systematic review.

Distraction in anterior plagiocephaly: technique, risks, and long-term results

The purpose of this study is to define the perioperative outcomes and long-term aesthetic outcomes of patients with unicoronal craniosynostosis (UCS) treated with fronto-orbital distraction osteogenesis (FODO) and compare them to a contemporaneous cohort treated with conventional fronto-orbital advancement and remodeling (FOAR). A retrospective review was performed for all patients treated at the Children’s Hospital of Philadelphia for non-syndromic UCS from 2009–2025. Demographic and perioperative data were collected. Preoperative and 5-year or greater postoperative frontal 2D photographs were used to assess for facial, and specifically periorbital, symmetry. Symmetry ratios were calculated to assess periorbital facial morphometry. Sixty-two patients were included in the study, 34 FODO, and 28 FOAR. FODO demonstrated significantly shorter anesthesia and surgical times, lower estimated blood loss, and shorter length of stay (all p < 0.001). The overall complication rate was similar (p = 0.175), but postoperative infection was more commonly reported in the FODO group (24 vs 1%, p = 0.033). Thirty-two patients had a 5-year or greater postoperative photographs, 16 FODO, and 16 FOAR. Patients in the FODO group were found to have greater improvements in palpebral width symmetry (0.32 vs -3.4, p = 0.039) and canthal tilt symmetry (1.51 vs -1.20 degrees, p = 0.035). One patient in the FOAR group required reoperation due to signs of elevated ICP. FODO results in improved perioperative and long-term aesthetic outcomes compared to FOAR, resulting in improved canthal tilt and palpebral width symmetry. Future studies should focus on severity-matched analyses.

Comparative outcomes of cryoextraction and conventional extraction in anterior and lateral orbitotomy for orbital cavernous venous malformations (so-called cavernous hemangioma)

Comparison of surgical outcomes of lateral orbitotomy and transconjunctival anterior orbitotomy using the swinging eyelid approach for cavernous venous malformations (CVM), with and without cryoextraction. In this single-center, retrospective case series (2005–2024), a single surgeon performed CVM excisions. Operative time and postoperative complications were compared across surgical approaches and extraction techniques for a cohort of 60 patients. Lateral orbitotomy was performed in 25 patients (14 conventional, 11 cryo-assisted) and the swinging eyelid approach in 35 patients (16 conventional, 19 cryo-assisted). In the swinging eyelid group, cryoextraction significantly reduced operative time (49.0 vs. 59.0 min, p = 0.04). A similar trend was observed in the lateral orbitotomy group, although the difference was not statistically significant (81.0 vs. 101.5 min, p = 0.23). Postoperatively, visual acuity remained stable or improved in 97% of patients. Diplopia occurred less frequently following cryo-assisted extraction and was transient in most cases, with persistent diplopia requiring further intervention occurring exclusively after conventional extraction. Cryoextraction is associated with shorter operative times and favorable functional outcomes in the surgical management of orbital cavernous venous malformations, particularly when using the swinging eyelid approach. When applied in appropriately selected cases, cryoextraction represents a safe and effective technique that may reduce surgical manipulation and postoperative morbidity.