Mini-Plication Surgery as a Valuable Tool for Surgical Treatment of Small Angle Residual Strabismus

Sep 30, 2026

Uploaded by Oliver

Mini-plication is a minimally invasive surgical approach designed to correct small-angle residual strabismus by creating a controlled fold of the extraocular muscle without detachment or excision. The method aims to preserve vascular supply and muscle integrity while enabling precise correction of minor deviations with a lower complication profile than traditional rectus procedures. A prospective review evaluated efficacy and safety as a standalone intervention in adult and eligible cases.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages5

Reading Time13 min

AccessFree to download

Abstract

Introduction

Methods

Prospective patient cohort

Surgical technique

Results

Conclusion

Materials And Methods

Inclusion criteria

Exclusion criteria

Received 10/10/2025 Review began 10/22/2025 Review ended 11/30/2025 Published 12/07/2025 © Copyright 2025 S et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98662 Open Access Original Article Published via Subbaiah Research Institute Mini-Plication Surgery as a Valuable Tool for Surgical Treatment of Small Angle Residual Strabismus Lakshmi K. S 1, Deepti P 2, Krishnaprasad R 2 1. Ophthalmology, Subbaiah Institute of Medical Sciences, Shivamogga, IND 2. Ophthalmology, Mahipathi Madhwacharya Joshi Eye Institute, Hubballi, IND Corresponding author: Lakshmi K. S, [lakshmimurthy1@gmail.com](lakshmimurthy1@gmail.com) Abstract Introduction Mini-plication is a relatively novel, minimally invasive surgical approach for the management of smallangle strabismus for small-angle residual strabismus. By creating a controlled fold of the extraocular muscle without detachment or excision, this technique preserves vascular supply and muscle integrity, allowing precise correction of minor deviations with reduced risk of complications compared to traditional procedures. Its technical simplicity and reversibility render it a promising option for patients requiring subtle ocular realignment. This study aims to evaluate the efficacy and safety of mini plication as a standalone intervention for small-angle residual strabismus. Methods A prospective analysis was performed involving nine patients (median age 66 years) who underwent miniplication. The technique involved placing a 6-0 polyglactin suture through the central 3-4 mm portion of the muscle belly, situated nearly mm behind its insertion, and then advancing the suture through the sclera to secure a knot just in front of the muscle insertion. This creates a central fold that produces the needed plication effect. Results Patients presented with preoperative strabismus ranging from 10 to 16 prism diopters (mean, 12Δ) . Postoperative deviations were reduced to a range of 2 to 8Δ (mean, 5.8Δ), yielding an average correction of 9Δ . No intraoperative or postoperative complications were observed. Conclusion Mini plication performed for small-angle residual strabismus under controlled anesthesia appears to be a safe, effective, and straightforward surgical alternative to prismatic correction for residual small-angle strabismus. This technique may be particularly beneficial for adult patients with residual deviations who seek a definitive treatment without reliance on spectacles. Categories: Ophthalmology Keywords: exotropia, mini-plication, prism diopters, residual strabismus, small angle strabismus Introduction Rectus muscle procedures, such as resection and full plication, which tighten the muscle, are used to treat strabismus with deviations of more than 15D. Both these strengthening procedures usually require either general anesthesia or local anesthetic block, such as peri-bulbar or retro-bulbar anesthesia. They comprise identifying and hooking the muscle, extensive posterior dissection of the muscle, and the resection or plication of the muscle, depending on the procedure chosen. Resection of muscle entails disinsertion, which disrupts the anterior ciliary blood supply and may cause anterior segment ischemia. One other major complication can be losing the muscle, which is catastrophic in inexperienced hands [1] . The full plication surgery for strabismus is advantageous when compared with the muscle resection surgery because total muscle disinsertion is not involved, and hence there is no risk of a lost muscle and nearly no risk of anterior segment ischemia. It is a reversible surgical procedure, especially when done within 5 days of surgery [2] . Evidence from iris fluorescein angiograms has proved beyond doubt that the

FAQs

What is mini-plication, and why is it used for small-angle residual strabismus?

Mini-plication tightens the central part of the extraocular muscle by forming a controlled fold without detachment or excision, aiming to correct small-angle residual deviations while preserving muscle integrity and vascular supply.

How was mini-plication performed in the study?

A 6-0 polyglactin suture was placed through the central 3–4 mm portion of the muscle belly near its insertion and then advanced through the sclera to secure a knot just in front of the insertion, creating the plication effect.

What were the outcomes and complication rates after surgery?

Preoperative deviations of 10–16 prism diopters were reduced to 2–8 prism diopters postoperatively, with an average correction of 9 prism diopters; no intraoperative or postoperative complications were observed.

Sep 30, 2026

Uploaded by Oliver