Tesis

Perbandingan Efektivitas Teknik Penjahitan Otot Three-Point Fixation Standar Dengan Modifikasi Terhadap Komplikasi Slipped Muscle Dan Inflamasi Pasca Operasi Strabismus: Evaluasi Makroskopik Dan Histopatologi Pada Kelinci Model = Comparison of the Effectiveness of Standard Three-Point Fixation Muscle Suturing Technique with Modification on Slipped Muscle Complication and Post-Strabismus Inflammation: Macroscopic and Histopathological Evaluation in Rabbit Models.

Latar Belakang: Strabismus sekunder dapat disebabkan oleh stretched scar, slipped muscle ataupun lost muscle. Slipped muscle adalah kondisi bergesernya otot ke arah posterior di dalam kapsul otot, yang dapat dipengaruhi oleh jahitan otot yang kurang adekuat. Operasi perbaikan slipped muscle merupakan prosedur yang kompleks dengan hasil luaran yang kurang baik. Teknik penjahitan otot dengan three-point fixation dipikirkan dapat mengurangi kejadian slipped muscle, meringankan respon inflamasi dan jaringan fibrosis pada otot ekstraokular pasca operasi strabismus. Tujuan: Membandingkan efektivitas antara teknik penjahitan otot three-point fixation standar (3PFS) dengan three-point fixation modifikasi locked central double-looping (3PFM) terhadap kejadian slipped muscle dan inflamasi pasca operasi strabismus pada hewan coba kelinci model. Metode: Penelitian eksperimental ini dilakukan pada kelinci model yang dilakukan operasi reses otot rektus superior. Setiap kelinci akan dilakukan operasi satu sisi mata dengan teknik three-point fixation standar dan sisi mata lain dengan teknik modifikasi, berdasarkan randomisasi acak sisi mata dan dilakukan blinding. Satu bulan pasca operasi, dilakukan penilaian posisi tepi otot dan jahitan lalu menggunakan metode superimposisi foto. Kedua mata kelinci dienukleasi untuk dibuat slaid histologis yang akan dinilai skor inflamasi serta persentase proporsi jaringan fiboris. Hasil: Enam kelinci (12 mata) dilakukan reses rektus superior dengan kedua teknik standar dan modifikasi, Benang jahit ditermukan pada sepuluh slaid mata. Secara klinis makroskopik slipped muscle, dua dari enam mata pada kelompok 3PFS mengalami slipped muscle sedangkan pada kelompok 3PFM terjadi pada satu mata (p=0,50). Skor inflamasi lebih rendah pada kelompok 3PFM, uji Mann Whitney (p=0,228). Persentase area fibrosis teknik 3PFM lebih rendah (11,20% (2,10%–16,50%)) dibandingkan teknik 3PFS (median 13,30% (3,20%– 19,30%)), dengan nilai p=0,690. Kesimpulan: Tidak terdapat perbedaan kejadian slipped muscle, skor inflamasi, dan persentase area fibrosis antara kelompok teknik 3PFM maupun 3PFS. Kedua teknik dapat digunakan dengan pertimbangan preferensi dan keahlian operator.
Kata Kunci: slipped muscle, inflamasi, fibrosis, otot ekstraokular, penjahitan otot three-point fixation


Background: Secondary strabismus can be caused by stretched scar, slipped muscle or lost muscle. Slipped muscle is a condition where the muscle shifts posteriorly inside the muscle capsule, which can be influenced by inadequate muscle sutures. Slipped muscle repair surgery is a complex procedure with poor prognosis. The muscle suturing technique with three-point fixation is thought to reduce the incidence of slipped muscle, reduce the inflammatory response and tissue fibrosis in extraocular muscles after strabismus surgery. Objective: To compare the effectiveness of the standard three-point fixation (3PFS) muscle suturing technique with the modified three-point fixation locked central double-looping (3PFM) on the incidence of slipped muscle and inflammation after strabismus surgery in experimental rabbit models. Methods: This experimental study was conducted on rabbit model that underwent superior rectus recession surgery. Each rabbit undergo surgery on one side of the eye using the standard three-point fixation technique and the fellow eye using a modified technique, based on random randomization and blinding. One month after surgery, we assed the the position of the muscle edges and sutures with photo superimposition method. Both rabbit eyes were enucleated to make a histological slide to assess the inflammation score and the percentage of fibrous tissue proportion. Result: Six rabbits (12 eyes) underwent superior rectus recess using both standard and modified techniques. Suture threads were found in ten eyes. Clinically slipped muscle, two of the six eyes in the 3PFS group experienced slipped muscle, while in the 3PFM group it occurred in one eye (p=0.50). Inflammation scores were lower in the 3PFM group, Mann Whitney test p=0.228. The percentage of fibrosis area for the 3PFM technique was lower (11.20% (2.10%– 16.50%)) than for the 3PFS technique (median 13.30% (3.20%–19.30%)), with a p value = 0.690. Conclusion: There was no difference in the incidence of slipped muscle, inflammation score, and percentage of fibrosis area between the 3PFM and 3PFS technique groups. Both techniques can be used with consideration of operator preference.
Keywords: slipped muscle, inflammation, fibrosis, extraocular muscle, three-point fixation muscle suturing technique