Minimally Invasive Strabismus Surgery (MISS) Compared with the Fornix Approach in Pediatric Horizontal Strabismus Surgery

Objective: To compare minimally invasive strabismus surgery (MISS) with the fornix approach in horizontal strabismus operations. Patients and methods: We performed a retrospective study of all patients aged <= 12 years who underwent symmetrical surgery of the medial or lateral recti over a 1-year period. MISS was performed in one eye, and fornix opening was performed in the contralateral. We compared pre- and postoperative visual acuity (VA), conjunctival hyperemia, swelling after surgery, and operating time. The techniques were performed by 2 surgeons after a 4-year training period. Results: The sample comprised 16 patients, with a mean age of 6.75 +/- 3.02 years. The medial rectus was operated on in 9, the lateral rectus in 7 cases. Recession was performed in 14 muscles (mean dose, 5mm) and plication in 2 (5.5mm and 7 mm, respectively). MISS was performed in 12 right eyes and 4 left eyes. Preoperative VA was 0.77 in MISS and 0.80 in the control group. VA was 0.83 in MISS and 0.76 in the control group 1 day after surgery. No significant differences were found for conjunctival hyperemia between the MISS and fornix groups 1 day or 1 week after surgery. Nevertheless, moderate/severe conjunctival hyperemia was less frequent in the MISS group (31.3% versus 62.5%). No significant differences were found for operating time (14.43 minutes [MISS] vs 12.37 minutes [control]). Conclusion: The MISS technique was similar to the fornix approach in the early postoperative period with respect to VA, conjunctival inflammation, and operating time in pediatric horizontal strabismus surgery.