Minimally invasive strabismus surgery

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Minimally invasive strabismus surgery (MISS) is the name given to the technique of eye muscle surgery, in which, in contrast to conventional surgical procedures, access to the surgical area is only made possible with very small openings in the conjunctiva. The procedure was essentially introduced clinically by the Swiss ophthalmologist Daniel Mojon from around 2007 after the Belgian ophthalmologist Marc Gobin first described the approach in a French-language specialist book in 1994.

indication

MISS is a procedure that can be used for all forms of strabismus disorders and supports the following surgical methods: repositioning, folding, resection, thread surgery (according to Cüppers ), transposing and repetition of straight eye muscles as well as repositioning and free and instrumental folds of inclines Eye muscles.

It is of the opinion that the procedure could support the decision for an outpatient procedure in a corresponding patient group. In strabismus surgery, MISS has not yet established itself as a standard method of access to the respective surgical area, but the underlying principles are becoming more widespread among ophthalmologists and eye clinics.

principle

In the case of an MISS procedure, the use of a surgical microscope is preferable to the use of magnifying glasses . Instead of the relatively large opening of the conjunctiva, also known as the “door wing technique”, access to the operating area is created with very small incisions of a few millimeters in size in the immediate anatomical proximity of the eye muscle to be operated on. These mini-incisions are made so far away from the limbus , the transition from the dermis and conjunctiva to the cornea , that this area is covered by the lids after the procedure and thus remains cosmetically inconspicuous. A “tunnel” is formed between two incisions, in which the surgeon uses fine instruments to carry out the necessary intervention. Should a complication arise during the operation, the opening of the conjunctiva can still be enlarged to the size of the classic door leaf incisions.

Clinical results

The results of minimally invasive strabismus surgery with regard to the postoperative position of the eyes are widely described as being comparable to the classic surgical method. This was also shown in a direct comparison of both methods in 40 children, with those who were operated on with MISS exhibited less swelling of the conjunctiva and eyelids postoperatively. The lower complication rates and the faster rehabilitation of the patients are established as essential advantages of MISS. The effectiveness of the method has been documented for both the surgery on the straight eye muscles and the surgery on the oblique eye muscles.

An Indian group of authors has reported on the effectiveness of MISS in patients whose eye misalignment was due to a thyroid disease, Graves' disease .

advantages

The advantages of the minimally invasive technique are the avoidance of corneal complications and the lowering of the risk of insufficient blood flow ( ischemia ) in the anterior segment of the eye. Wound healing is faster postoperatively, conjunctival hematomas occur less frequently. In revision surgery, stronger adhesions between the conjunctiva and the sclera can usually be avoided.

Risks

MISS is a more time consuming procedure than other eye muscle surgery techniques. The small "keyhole openings" can tear more easily in older patients. If the tear extends to Tenon's capsule , a scar can remain. If abnormally heavy bleeding occurs, the small incisions must be widened to perform cautery . However, there have been few reports of complications specific to the minimally invasive method of squint surgery.

Publications

  • Ronald D. Barley: Small cuts against squinting. In: Neue Zürcher Zeitung. July 21, 2010.
  • Martina Frei: After a mini cut, look straight ahead again. In: Tagesanzeiger. January 22, 2008.
  • DS Mojon: Minimally invasive strabismus surgery. In: Br J Ophthalmol. 93 (6), 2009, pp. 843-844.
  • DS Mojon: Minimally invasive strabismus surgery. In: HI Fine, DS Mojon (Ed.): Minimally invasive ophthalmic surgery. Springer: 'Heidelberg, 2009, pp. 123–152.
  • DS Mojon: A new transconjunctival muscle reinsertion technique for minimally invasive strabismus surgery. In: J Pediatr Ophthalmol Strabismus. 47, 2010, pp. 292-296.
  • DS Mojon: Review: minimally invasive strabismus surgery. In: Eye. 29, 2015, pp. 225-233.

Web links

  • Daniel Mojon: Schield diagnostics and minimally invasive squint surgery procedures. - PDF last opened May 27, 2018 rosenfluh.ch

Individual evidence

  1. ^ DS Mojon: Comparison of a new, minimally invasive strabismus surgery technique with the usual limbal approach for rectus muscle recession and plication. In: Br J Ophthalmol. 91 (1), Jan 2007, pp. 76-82.
  2. ↑ MH Gobin, JJM Bierlaagh: Surgery horizontal et cyclo verticale du simultane'e strabisme. Center for Strabology, Antwerp 1994.
  3. ↑ Minimize trauma, discomfort and complications. MISS - minimally invasive strabismus surgery. In: Ophthalmological News. Issue 10, 2010.
  4. ↑ Ronald D. Gerste : Small cuts against the squint. In: Neue Zürcher Zeitung . July 21, 2010.
  5. ↑ Ronald D. Gerste: Ophthalmic surgery: Miniaturization is advancing. In: Deutsches Ärzteblatt . Volume 108, No. 4, 2011, pp. A-162 / B-124 / C-124.
  6. ↑ 28th International Congress of German Ophthalmic Surgeons , 2015: Current overview of minimally invasive squint surgery.
  7. ↑ Ronald D. Gerste: Ophthalmic surgery: Miniaturization is advancing. In: Deutsches Ärzteblatt. 108, 2011, pp. A-162.
  8. ↑ P. Gupta, S. Dadeya, Kamlesh, V. Bhambhawani: Comparison of Minimally Invasive Strabismus Surgery (MISS) and Conventional Strabismus Surgery Using the Limbal Approach. In: J Pediatr Ophthalmol Strabismus. 54 (4), Jul 1, 2017, pp. 208-215.
  9. ↑ I. Asproudis, N. Kozeis, A. Katsanos, S. Jain, PG Tranos, AG Konstas: A Review of Minimally Invasive Surgery Strabismus (MISS): Is This the Way Forward? In: Adv Ther. 34 (4), Apr 2017, pp. 826-833.
  10. ↑ P. Merino, I. Blanco Domínguez, P. Gómez de Liaño: Outcomes of minimally invasive strabismus surgery for horizontal deviation. In: Arch Soc Esp Oftalmol. 91 (2), Feb 2016, pp. 69-73.
  11. ↑ N. Pellanda, DS Mojon: Combined horizontal rectus muscle minimally invasive strabismus surgery for exotropia. In: Can J Ophthalmol. 45 (4), Aug 2010, pp. 363-367.
  12. ^ DS Mojon: Minimally invasive strabismus surgery for rectus muscle posterior fixation. In: Ophthalmologica. 223 (2), 2009, pp. 111-115.
  13. ^ DS Mojon: Minimally invasive strabismus surgery (MISS) for inferior obliquus recession. In: Graefes Arch Clin Exp Ophthalmol. 247 (2), 2009, pp. 261-265.
  14. ^ MN Naik, AG Nair, A. Gupta, S. Kamal: Minimally invasive surgery for thyroid eye disease. In: Indian J Ophthalmol. 63 (11), Nov 2015, pp. 847-853.
  15. ↑ Tips for new users of MISS technology. In: Ophthalmological News. Issue 3, 2014.
  16. ↑ DS Mojon: Review: minimally invasive strabismus surgery. In: Eye. 29, 2015, pp. 225-233.