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Comment & Response |

Rectus Muscle Plication Procedure

Kenneth W. Wright, MD1,2,3
[+] Author Affiliations
1Wright Foundation for Pediatric Ophthalmology and Strabismus, Los Angeles, California
2Cedars-Sinai Medical Center, Los Angeles, California
3Keck School of Medicine, University of Southern California, Los Angeles
JAMA Ophthalmol. 2015;133(2):226-227. doi:10.1001/jamaophthalmol.2014.4259.
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To the Editor The rectus muscle plication is a useful strabismus surgical procedure as reported by Chaudhuri and Demer in the article titled “Surgical Outcomes Following Rectus Muscle Plication: A Potentially Reversible, Vessel-Sparing Alternative to Resection.”1 I first published the rectus plication procedure in 1991 and called it a modified rectus tuck.2 The modification involved suturing muscle to sclera, in contrast to a tuck that sutures muscle to muscle. The standard muscle-to-muscle tuck relaxes over time and was therefore generally abandoned. When I originally published the technique, like Chaudhuri and Demer, I classified it as a strengthening procedure. The plication is actually a rectus muscle tightening procedure. This distinction is important when planning strabismus surgery as tightening limits eye movement, whereas strengthening increases eye movement. A plication of the right medial rectus muscle causes slight limitation of abduction, thus inducing an eso shift in right gaze and having little effect in left gaze. A strengthening procedure would do the opposite and induce an eso shift in left gaze. Hence, an exotropia increasing in right gaze is best treated with a right medial rectus plication.

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February 1, 2015
Zia Chaudhuri, MS, FRCS(Glasg); Joseph L. Demer, MD, PhD
1Lady Hardinge Medical College and Associated Hospitals, New Delhi, India2Postgraduate Institute of Medical Education and Research, New Delhi, India3Dr Ram Manohar Lohia Hospital, New Delhi, India
4Stein Eye Institute, University of California, Los Angeles
JAMA Ophthalmol. 2015;133(2):227. doi:10.1001/jamaophthalmol.2014.4263.
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