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Squint Free Papers therapy. Medical therapy for amblyopia was well tolerated with no significant adverse effects reported. In conclusion though medical therapy for amblyopia was well tolerated, it was met with very marginal success without occlusion. Occlusion therapy remains the gold standard for the treatment of amblyopia, medical therapy can be used as adjuvant to PTO or in patients with poor compliance for occlusion. REFERENCES 1. Gottlob I, Weghaupt H, Vass C. Effect of levodopa on the human luminance electroretinogram. Invest Ophthalmol Vis Sci 1990;31:1252-8. 2. Leguire LE, Walson PD, Rogers GL, et al. Levodopa/carbidopa treatment for amblyopia in older children. J Pediatr Ophthalmol Strabismus 1995;32:143-51. 3. Methods Find Exp Clin Pharmacol. Citicholine: pharmacological and clinical review, 2006 update. 2006 Sep;28 Suppl B:1-56. 4. José Fernando Maya Vetencourt, et al The Antidepressant Fluoxetine Restores Plasticity in the Adult Visual Cortex. Science 2008;320, 385. Is Minimally Invasive Strabismus Surgery Worth Going For? A Paired Study Dr. Richa Sharma, Dr. Amitava A.K. M 1 inimal access surgery are common in all the fields of medicine. Ophthalmology too has witnessed an effort to reduce the size of incision For example: phacoemulsification, miniature implant drainage surgery, sutureless vitrectomy, endoscopic lacrimal surgery etc. Apart from providing functional benefit such as fusion and stereopsis, strabismus surgery serves to improve cosmesis. In an immediate post op period, that would mean an eye with less redness, congestion, chemosis and watering. This can be achieved by giving smaller size of the incision, less tissue trauma and ability to dispense off the sutures at least on conjunctiva. Most of the strabismus surgeons prefer to give limbal incision in the quadrant of interest introduced by Harms and later popularized by Von noorden. 2,3 Some surgeons also prefer to chose Fornix incision approach popularized by Parks. 4 Several other conjunctival approaches have been introduced by these authors Velez, Santiago, Swan And Talbott. 5,6,7 Recently, in 2007 a novel technique for muscle exposure has been introduced by Daniel S Mojon in which 2 incisions parallel to muscle strap were given and further recessions and plication done through the tunnel made after 805
806 70th AIOC Proceedings, Cochin 2012 separating muscle from the surrounding tissue. This study was done in 39 patients, 20 of which underwent Minimally invasive strabismus surgery (MISS) and it was compared with 19 patients who underwent limbal incision surgery retrospectively. There outcomes were the alignment in the two groups, binocular single vision, variation in vision , patient’s s discomfort and number and type of complications. 8 While the above mentioned study was a group randomization, we designed a parallel study in which one eye was randomized to MISS and other to Standard paralimbal surgery (SPS) to compare post operative outcome in terms of cosmesis and discomfort in the two techniques. Oue primary outcomes being redness, congestion, chemosis, discomfort and foreign body sensation. Final alignment was not our primary but secondary outcome. We also evaluated total time taken, visible scarring, and any complications. MATERIALS AND METHODS 20 eyes of ten patients were included in the study. After proper consent, eyes were randomized to each group. Both the eyes were anaesthetized by giving peribulbar block using xylocaine (2%), sensoricaine (0.5%) with hyaluronidase. After separating the lids with universal eye speculum, a 5-0 silk traction suture (Johnson & Johnson Ltd Aurangabad NW 5079) was passed through the superficial sclera near the limbus in the quadrant of the muscle to be operated upon. Care was taken that the 5-0 silk suture does not contact/ abrade the cornea. Linear conjunctival incisions, parallel to the edges of the muscle of interest were given, their anterior limits being adjacent to the insertion of the muscle. For recessions Their posterior limits were about 1 mm short of the planned recession. From the access available through the two linear parallel cuts, after hooking the muscle, the episcleral tissue was cleared, and careful dissection to expose the muscle margins (including intermuscular septum) and surface was undertaken with Westcott scissors, till about 7 mm behind the insertion. Vicryl 6-0 (Johnson & Johnson Ltd. Aurangabad NW 2670) bites were taken from the muscle margins from near the insertion, and the muscle disinserted using spring scissors. Hemostasis was be undertaken at this stage in case a need is felt. After measuring the distance for the desired recession, Vicryl 6-0 scleral bites (of the previously passed suture through the muscle margins) was taken so as to provide a new anchor to the EOM. Care was exercised to ensure that the cut edge of the muscle is stretched, so as to prevent the central sagging of the muscle tendon. If the parallel conjunctival cut edges appeared to be in
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