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

Introduction Mini-plication is a relatively novel, minimally invasive surgical approach for the management of small-angle 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 mini-plication. 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.