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Mini-plication to treat small-angle strabismus: A minimally invasive procedure
Letters to the Editor MINI-PLICATION TO TREAT SMALL-ANGLE STRABISMUS: A MINIMALLY INVASIVE PROCEDURE To the Editor: Leenheer and Wright1 described a miniplication of a rectus muscle to treat small-angle strabismus. This procedure, which involves plication of only the central muscle fibers, is a minor modification of the lineal tucking procedure that was first described in the Spanish literature in 19802 and subsequently in the English literature in 1983.3 For more than 20 years Art Jampolsky has referred to it as a “Mexican tuck” in symposia and in lectures (unpublished written personal communication, October 3, 2012). As I see it, the minor difference between the procedure described by Leenheer and Wright1 and the one reported initially by RamirezBarreto et al2 is that they perform their procedure with the patient under topical anesthesia and limit the surgery to small-angle strabismus. Both procedures plicate (or tuck) only the central fibers of the muscle. I have published numerous reports describing good results with this procedure,4-6 and I can attest that tucking the central fibers of the muscle is easy and effective. I am glad that Leenheer and Wright have confirmed these findings. David Romero-Apis, MD Department of Strabismus Hospital de la Luz Mexico City, Mexico References 1. Leenheer RS, Wright KW. Mini-plication to treat small-angle strabismus: A minimally invasive procedure. JAAPOS 2012;16:327-30. 2. Ramırez Barreto MA, Murillo Murillo L, Cerro MC. Plegamiento lineal como acortamiento en cirugıa de estrabismo. Anal Soc Mex Oftalmol 1980;54:49. 3. Romero Apis D, Martinez Oropeza S. Strabismus surgery by means of marginal myotomy combined with lineal tucking. Am Orthopt J 1983; 33:74. 4. Tenorio G, Fonte Vazquez A, Espinosa Olvera Y. Retroinserci onresecci on muscular y miotomıa marginal-plegamiento muscular lineal: Estudio comparativo. Anal Soc Mex Oftalmol 1981;55:155. 5. Cerro MC, Ramırez Barreto MA. Miotomıa-plegamiento vs resecci onretroinserci on. Anal Soc Mex Oftalmol 1989;54:54. 6. Ramırez Barreto MA. Plegamiento como tecnica de reforzamiento en los m usculos rectos. In: Yllanes A, editor. Temas selectos de estrabismo. Mexico: Centro Mexicano de Estrabismo; 1993. p. 166-70. http://dx.doi.org/10.1016/j.jaapos.2012.10.006 J AAPOS 2013;17:337. Copyright Ó 2013 by the American Association for Pediatric Ophthalmology and Strabismus. 1091-8531/$36.00
REPLY To the Editor: We thank Dr. Romero-Apis for his thoughtful comments and for his attention to our work. We agree that our procedure and his previously published
Journal of AAPOS
procedure do involve tightening of the central muscle fibers. Our procedure is not the same as the one he described because the central muscle is secured to the sclera. A plication is muscle to sclera and promotes stronger wound healing than a tuck, which is muscle to muscle. He is also correct that this procedure was designed to be performed under topical anesthesia and for smallerangle strabismus; however, it need not be limited in this respect. It can be used in larger deviations to help tighten the antagonist of a recessed rectus muscle. We agree that this is an effective procedure and are thankful for international collaboration. Rebecca S. Leenheer, MD Family Eye Care/Childrens Eye Center Albuquerque, New Mexico Kenneth W. Wright, MD Wright Eye Center Los Angeles, California http://dx.doi.org/10.1016/j.jaapos.2013.03.013 J AAPOS 2013;17:337. Copyright Ó 2013 by the American Association for Pediatric Ophthalmology and Strabismus. 1091-8531/$36.00
FIRST BILATERAL PEDIATRIC DESCEMET STRIPPING AUTOMATED ENDOTHELIAL KERATOPLASTY AFTER FAILED PENETRATING KERATOPLASTY To the Editor: In a previously published report,1 we described the case of a 4-year-old boy who underwent Descemet stripping automated endothelial keratoplasty (DSAEK) for the treatment of a failed penetrating keratoplasty (PK) graft in his left eye. The boy had been bilaterally treated with PK at 1 year of age for the management of congenital hereditary endothelial dystrophy. His left eye suffered from corneal edema after an episode of graft rejection. DSAEK was considered as the best treatment option to avoid intraoperative and postoperative complications related to PK, such as expulsive hemorrhage, suture-related complications, and wound dehiscence.1 Shortly after his rehabilitation from DSAEK surgery in the left eye, the boy also developed corneal edema in the right eye. Best-corrected visual acuity decreased from 20/200 to counting fingers at 2 m, and the boy suffered from photophobia and tearing. Slit-lamp examination revealed diffuse corneal stromal edema. To decide on a treatment, all possible complications of PK in an active 5-year-old child were considered, as were the increased failure rate of repeat pediatric PK2 and the previous success of DSAEK treatment of his left eye 9 months earlier. The parents consented to DSAEK in his right eye. The precut DSAEK graft was trephined in a diameter of 7.5 mm—0.5 mm larger than in the left eye—to better fit
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REPLY To the Editor: We thank Dr. Romero-Apis for his thoughtful comments and for his attention to our work. We agree that our procedure and his previously published
Journal of AAPOS
procedure do involve tightening of the central muscle fibers. Our procedure is not the same as the one he described because the central muscle is secured to the sclera. A plication is muscle to sclera and promotes stronger wound healing than a tuck, which is muscle to muscle. He is also correct that this procedure was designed to be performed under topical anesthesia and for smallerangle strabismus; however, it need not be limited in this respect. It can be used in larger deviations to help tighten the antagonist of a recessed rectus muscle. We agree that this is an effective procedure and are thankful for international collaboration. Rebecca S. Leenheer, MD Family Eye Care/Childrens Eye Center Albuquerque, New Mexico Kenneth W. Wright, MD Wright Eye Center Los Angeles, California http://dx.doi.org/10.1016/j.jaapos.2013.03.013 J AAPOS 2013;17:337. Copyright Ó 2013 by the American Association for Pediatric Ophthalmology and Strabismus. 1091-8531/$36.00
FIRST BILATERAL PEDIATRIC DESCEMET STRIPPING AUTOMATED ENDOTHELIAL KERATOPLASTY AFTER FAILED PENETRATING KERATOPLASTY To the Editor: In a previously published report,1 we described the case of a 4-year-old boy who underwent Descemet stripping automated endothelial keratoplasty (DSAEK) for the treatment of a failed penetrating keratoplasty (PK) graft in his left eye. The boy had been bilaterally treated with PK at 1 year of age for the management of congenital hereditary endothelial dystrophy. His left eye suffered from corneal edema after an episode of graft rejection. DSAEK was considered as the best treatment option to avoid intraoperative and postoperative complications related to PK, such as expulsive hemorrhage, suture-related complications, and wound dehiscence.1 Shortly after his rehabilitation from DSAEK surgery in the left eye, the boy also developed corneal edema in the right eye. Best-corrected visual acuity decreased from 20/200 to counting fingers at 2 m, and the boy suffered from photophobia and tearing. Slit-lamp examination revealed diffuse corneal stromal edema. To decide on a treatment, all possible complications of PK in an active 5-year-old child were considered, as were the increased failure rate of repeat pediatric PK2 and the previous success of DSAEK treatment of his left eye 9 months earlier. The parents consented to DSAEK in his right eye. The precut DSAEK graft was trephined in a diameter of 7.5 mm—0.5 mm larger than in the left eye—to better fit
337