Competitive analysis of intraoperative adjustable suture with conventional suture technique in strabismus surgery

We compared the effectiveness of fixed conventional strabismus surgery (CSG) with a one-stage intraoperative adjustable suture technique in 88 patients undergoing strabismus surgery (ASG) either with fixed conventional (38) or intraoperative adjustable suture (50) technique. The mean correction of deviation with both near-fixation and distant-fixation for the ASG and CSG were not different. One-stage intraoperative adjustable suture technique is safe and effective method for strabismus surgery for cooperative patients. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which includes unlabeled, unapproved, or investigative products or devices.     

Eficacia y seguridad de la sutura ajustable en estrabismos horizontales: estudio comparativo de niños frente a adultos

ObjectiveAdjustable suture procedures allow addressing the unpredictability of some postoperative results in strabismus surgery. The purpose of the study was to compare the effectiveness of adjustable and non-adjustable suture in the treatment of horizontal strabismus in children and adults.MethodsProspective study including patients undergoing strabismus surgery to correct horizontal strabismus with fixed hanging suture (non-adjustable suture group) and adjustable suture. Visual acuity, amblyopia, deviation, oblique muscle involvement, previous surgeries, nystagmus, need for adjustment, and complications were recorded. The variables were recorded in the immediate postoperative period, at one week and at 3 and 6 months.Results186 patients were included: 157 (84.4%) with adjustable suture and 29 (15.6%) with non-adjustable suture, of which 119 were children and 67 were adults. Postoperatively, 19 children (16.0%) and 19 adults (28.4%) required adjustment (P = .044). Of 157 patients with adjustable suture, it was adjusted in 20% (32/157). Success after adjustment was higher for adjustable suture (91.72% vs 79.31%; P = .043) and remained for 6 months (P < .05). Previous surgery (P = .004) and exotropia (P = .018) correlated with the need for adjustment.Conclusions20% of patients with horizontal strabismus can benefit from a postoperative adjustment to improve the surgical result. The adjustable suture was shown to be superior to the fixed hanging suture and is an excellent surgical option, both in children and adults.     

Strabismus surgery outcomes after scleral buckling procedures for retinal reattachment

Abstract

Objective: To investigate the outcomes of strabismus surgery in patients with a prior history of a scleral buckling procedure for retinal reattachment.

Methods: We reviewed the medical records of 18 patients who underwent strabismus surgery following a scleral buckling procedure and investigated the effect of multiple variables on postoperative alignment after strabismus surgery including gender, age, surgeon, number of strabismus surgeries, adjustable suture use, previous pars plana vitrectomy, preoperative best-corrected visual acuity, and scleral buckle removal. Outcomes were considered successful if there was ≤10 prism diopters (PD) residual horizontal and/or ≤4 PD residual vertical deviations. Statistical analyses were performed using Fisher’s exact test, Mann-Whitney test, and nominal logistic regression.

Results: Success using our criteria of motor alignment was achieved in 6 of 18 eyes (33%). A higher rate of success was found in the scleral buckle removal group (success with buckle removal, 62.5%; success without buckle removal, 10.0%; p?=?0.04). Nominal logistic regression analysis showed scleral buckle removal was the most significant factor associated with successful surgical alignment (p?=?0.03; odds ratio?=?16.67). Although the success rate was higher in the adjustable suture group (50% in adjustable group vs 14.3% in non-adjustable group: Fisher’s exact test, p?=?0.30), this difference was not statistically significant. No retinal redetachments occurred after scleral buckle removal.

Conclusions: These results suggest that scleral buckles can be safely removed in selected patients with strabismus following retinal reattachment surgery and scleral buckle removal may improve ocular alignment following strabismus surgery.     

下斜肌肌腹转位术治疗轻度下斜肌亢进伴小度数垂直斜视

目的：观察下斜肌肌腹转位(IOBT)术在单眼下斜肌轻度亢进伴小度数垂直斜视中的应用效果。

方法：回顾性分析2019-09/2021-08在我院行IOBT术的患者,纳入标准为单眼下斜肌轻度亢进(2+及以下),并伴有轻度非共同性垂直斜视(4～9PD)。水平斜视按照常规手术量和方式设计,同期单侧下斜肌亢进眼行单眼IOBT术。观察手术前后水平斜视度、垂直斜视度、侧方注视位垂直斜视度、黄斑视盘夹角及下斜肌亢进程度等。

结果：纳入病例共16例16眼,年龄4～39岁。1例为先天性内斜视术后5a,单眼上斜肌轻度麻痹继发下斜肌功能亢进,余15例均为原发性下斜肌功能亢进伴水平斜视。随访时间为3～6mo。术前和术后平均下斜肌亢进程度分级分别为+2.00(2.00,2.00)级和0.00(0.00,0.00)级(Z=-3.704,P<0.001),平均改善2.00(1.25,2.00)级; 水平斜视度从术前69.13±25.86PD减少到术后2.75±2.59PD(t=9.929,P<0.001); 第一眼位垂直斜视从术前7.44±1.32PD减少到术后1.00±1.21PD(t=22.335,P<0.001),平均矫正上斜视为6.44±1.15PD; 侧方注视垂直斜视从术前12.44±2.73PD减少到术后3.00±2.13PD,平均矫正9.44±2.73PD(t=13.819,P<0.001)。黄斑中心凹-视盘中心夹角度数(FDA)术前为-8.85°±6.53°,术后为-6.49°±7.01°(t=-2.384,P<0.001),平均减少2.36°。未见术后过矫及下斜肌功能不足等并发症。

结论：IOBT术对矫正单侧轻度下斜肌亢进伴小度数垂直斜视是安全有效的。     

Surgical outcome of a new modification to muscle belly union surgery in heavy eye syndrome

ABSTRACT

Objectives: To report the clinical outcomes of a new modification to muscle belly union surgery in heavy eye syndrome.

Methods: Muscle belly union was performed in patients with large-angle esotropia and characteristic findings of heavy eye syndrome on orbital imaging. After isolation of superior and lateral rectus muscle and passing a single armed suture in each muscle belly, approximation was achieved via tying of both arms of separate sutures together. Medial rectus (MR) was also recessed considering the results of the intraoperative force duction test.

Results: Surgery was conducted in 24 eyes of 16 patients. The mean preoperative esotropia was 93.71 ± 23.1 prism diopters (PD), which improved significantly after the operation (final esotropia: 11.53 ± 15.59 PD, P value = 0.001). Six patients also exhibited mild hypotropia preoperatively (9.33 ± 6.88 PD), which resolved completely after surgery in all cases. Evaluation of preoperative abduction limitation (minus 3.1 ± 1.83) showed a significant improvement postoperatively (minus 0.95 ± 0.68, P value = 0.000). Additionally, mild limitation of adduction (minus 1) was seen in nine patients due to large MR recession. However, none of the patients reported postoperative diplopia.

Conclusion: Our new approach in muscle belly union surgery resulted in favorable outcomes compared with previous studies. It seems that the two-suture technique presented in this study yields more convenient approximation of muscle bellies and acts as a safety suture upon spontaneous loosening of the first applied suture.     

Retrobulbar anaesthesia for adjustable strabismus surgery in adults: a prospective observational study

Objective

To characterize the ocular response to retrobulbar anaesthesia and to evaluate the efficacy of retrobulbar anaesthesia for adjustable strabismus surgery in adults.

Outcomes of adjustable strabismus surgery in an Irish University Hospital

Purpose

Strabismus surgery aims to improve binocular vision, reduce diplopia, and enhance cosmesis. Adjustable strabismus procedures have been developed as a means of tackling unpredictability in some post-operative results. The purpose of the study was to compare the effectiveness of adjustable and non-adjustable squint procedures in the treatment of strabismus.

Methods

We analyzed adjustable or non-adjustable squint surgery undergone in our Irish locality by retrospectively studying 27 consecutive patients at Mater Misericordiae University Hospital, Dublin.

Results

There was no significant difference (p = 0.519) in the mean post-operative horizontal deviation between the adjustable group (mean = 11.6 PD) and the non-adjustable group (mean = 15.3 PD). We found that adjustable procedures resulted in a trend (p = 0.050) towards a greater mean horizontal effect per muscle (18.9 PD per muscle) than non-adjustable procedures (mean 9.7 PD). We went on to analyze the adjustable group in order to determine the impact on outcome in those patients in whom their adjustable sutures were manipulated postoperatively. Of the 11 patients who underwent adjustable procedures, 6 subsequently had adjustments made as planned and 5 did not require adjustment. Those patients who had their sutures adjusted demonstrated a smaller mean post-operative deviation (8.5 PD) than those patients in whom their suture was not adjusted (mean = 16.3 PD).

Conclusion

Our study displays a trend that adjustable procedures are more effective in terms of the mean horizontal effect per muscle operated, and is a novel way of reporting effectiveness of strabismus procedures.

     

Accuracy of suture adjustment in adjustable strabismus surgery evaluated at the initial postoperative examination

PURPOSE: To clarify the efficacy of sliding-noose type adjustable suture strabismus surgery, we evaluated the accuracy of suture adjustment based on data from the initial postoperative examination performed 1-4 weeks after the surgery. METHODS: Thirty-four patients with various types of strabismus participated [age range, 12-79 years; range of far deviation, 4-123 prism diopters (PD)]. Under sub-Tenon anesthesia, a recession (with or without a resection or muscle transposition) was performed with an adjustable suture (Guyton's procedure), and the suture was adjusted 6-24 hours after surgery. RESULTS: Twenty-six (76%) patients required suture adjustment one to eight times. In 50% and 75% of our patients, the errors from individual target angle were within +/- 0.8 and +/- 2.0 PD, respectively, whereas 2 (6%) patients with esotropia showed an undercorrection larger than 10 PD. The error distribution was almost the same throughout the range of preoperative deviation. CONCLUSION: By using an adjustable suture with a sliding noose, pinpoint alignment of the eyes can be achieved in more than half of the cases, at least in the early postoperative period.     

Accuracy of suture adjustment in sliding noose type adjustable strabismus surgery

PURPOSE: To clarify the efficacy of adjustable suture strabismus surgery with sliding noose, we evaluated the accuracy of suture adjustment. METHODS AND SUBJECTS: Thirty-four patients with various types of strabismus participated [age range: 12-79 years, range of far deviation: 4-123 prism diopters(PD)]. Under sub-Tenon anesthesia, a recession(with or without an additional resection or a muscle transposition) was performed with an adjustable suture(Guyton's procedure), and the suture was adjusted 6-24 hours after the surgery. Based on the initial postoperative examination performed 1-4 weeks(mean: 2.8 weeks) after the surgery, errors in the far deviation from the individual target were analyzed. RESULTS: Twenty-six(76%) patients required suture adjustment 1-8 times. In 50% and 75% of our patients, the errors were within +/- 0.8 and +/- 2.0 PD, respectively, whereas 2(6%) patients with esotropia showed an undercorrection larger than 10 PD. Distribution of the errors was the same throughout the range of pre-operative deviation. CONCLUSION: By using the sliding noose type adjustable suture, a pin-point alignment of the eyes can be established in more than 50% of cases, at least, in the early post-operative period.     

10-0尼龙缝线与8-0可吸收缝线在斜视手术中的应用比较

目的：探讨显微斜视术中球结膜切口使用10-0缝线与8-0可吸收缝线应用的比较。
　　方法：选取在我院行内、外斜视手术的患者,随机分为两组,其中32例41眼(对照组)球结膜切口使用10-0缝线缝合,30例38眼(观察组)球结膜切口使用8-0可吸收缝线缝合,均采用间断、线结埋藏式缝合,对两组术后1,2 wk;1 mo的切口愈合情况、患者自觉刺激症状进行观察比较。
　　结果：术后1,2 wk观察组切口发生缝线吸收、切口豁开的眼数分别是7眼、15眼,总的发生率为39%,对照组无1眼发生缝线吸收、切口豁开现象,发生率为0,二者之间比较差异具有统计学意义(P<0.05);术后1mo观察组患者有33眼切口仍有缝线残留,患者眼部充血、异物感等不适建议拆线,拆线率87%;对照组在术后2 wk时切口愈合良好,41眼全部拆线,拆线率100%,二者拆线率比较差异无统计学意义(P>0.05);术后切口愈合时间比较,观察组切口平均愈合时间为22.30±5.45d,对照组切口平均愈合时间为15.50±1.76d,两组比较差异有统计学意义( P<0.05);术后1,2wk两组眼部舒适度评分比较无明显差异( P>0.05),术后1mo对照组眼部舒适度评分(2.57±0.50)高于观察组(1.813±0.64),差异有统计学意义(P<0.05)。
　　结论：显微斜视术后球结膜切口采用8-0可吸收缝线患者舒适度与10-0缝线比较并没有优势,由于缝线的过早吸收,反而出现切口的延迟愈合,建议显微斜视术后仍采用10-0缝线缝合球结膜。     

Botulinum Toxin Treatment in Patients Up to 3 Years of Age Who Have Esotropic Duane Retraction Syndrome

ABSTRACT

Purpose: To report the results of botulinum toxin (BOTOX®, Allergan) type A (BTA) bilateral injection in the treatment of Duane retraction syndrome (DRS) type 1 in patients aged up to 3 years.

Methods: We studied the results of BTA bilateral injection in eight consecutive patients with DRS type 1 and esotropia in primary gaze. Average follow-up was 74?±?71 months. The main variables analyzed were horizontal and vertical deviation and face turn. Patients were anesthetized with nitrous oxide (N₂O). A mean dosage of 5.6?±?1.8?IU (range 2.5–7.5?IU) of botulinum toxin diluted in 0.9% saline solution was injected under electromyography control in each medial rectus muscle.

Results: Seven patients had one affected eye and one patient had bilateral involvement. The mean preoperative esotropia was 32?±?10 prism diopters (PD). Three patients (37.5%) had also a vertical deviation. All patients had face turn ranging between 15° and 45° before BTA injection. In the last follow-up, 4 patients were orthotropic (50%), 1 (12.5%) had 3 PD exotropia and 3 (37.5%) had esotropia averaging 25 PD mean. The 3 esotropic patients needed surgical correction. Vertical strabismus improved in 3 patients achieving complete resolution in one of these patients. Two patients, without vertical strabismus before the BTA injection, developed a 5-PD vertical deviation, one of them required surgery. Face turn improved in all patients.

Conclusion: Botulinum toxin injection is an alternative treatment for patients with DRS type 1 presents esotropia and face turn in children up to 3 years of age.     

Bupivacaine injection combined with recession of antagonist rectus muscle to treat sensory strabismus

Purpose: This study aims to evaluate the effect of bupivacaine injection at 1.5% combined with recession of the antagonist rectus muscle to treat sensory strabismus in adult patients.

Methods: Nine patients with a horizontal deviation, visual acuity of <20/60 in the worst-seeing eye, and no previous strabismus surgery were selected. Patients with vertical strabismus were excluded. Lateral rectus (LR) recession was performed in patients with exotropia and medial rectus (MR) recession in patients with esotropia according to Park’s Table, as modified by Wright. Bupivacaine 1.5 mL at 1.5% was injected in the antagonist of the recessed muscle. The patients were evaluated after 1, 7, 30, 60, 90, and 180 days of the procedure. Successful motor alignment was defined as within 10 prism diopters (PD) of orthophoria. Dose-response was considered as the total amount of correction, divided by recession performed in millimeters, associated with bupivacaine injection in the antagonist muscle.

Results: Of the patients, 44% (4/9) had a successful motor alignment. The mean correction for exotropia (n = 5) with a preoperative horizontal deviation of 50 ± 6.12 PD was 23 ± 14.4 PD with a dose-response of 2.6 PD/mm. For esotropia (n = 4), the mean correction of 21.25 ± 4.8 PD was achieved with a preoperative deviation of 28.7 ± 14.9 PD with a final dose-response of 5 PD/mm. All unsuccessful patients had a preoperative deviation of ≥45 PD.

Conclusion: Bupivacaine injection in the antagonist of a recessed extraocular muscle (EOM) appears to add an effect to the standard dose-response of a muscle recession. For patients with esotropia (<25 PD), a single MR recession combined with bupivacaine in the LR can produce a successful motor alignment. For patients with large horizontal strabismus (>45 PD), larger bupivacaine doses (volume and concentration) combined to larger recessions may be needed.     

Effect of Limited Tenon Capsule and Intermuscular Membranes Dissection on the Outcome of Surgery in Patients with Horizontal Strabismus

Purpose: The aim of the study was to evaluate the effect of limited dissection of Tenon capsule on the outcome of strabismus surgery.

Methods: Patients between the ages of 2 and 50 years with pure horizontal strabismus were enrolled in a prospective study. Patients were divided into two groups: case and control as a non-randomized study. The method of operation was similar in both groups except for the amount of sheath Tenon dissection. In the control group the intermuscular connections and Tenon capsule were cut as much as possible. In the study group, Tenon capsule, 3-4 mm posterior to the location of the sutures over the muscle (recessed or resected), were cut and intermuscular connections remained intact.

Results: The study enrolled 54 patients with 27 patients in each group. In both groups, after operation, regardless of the type of surgery, the angle of strabismus was reduced (P< 0.05). For patients who had undergone bimedial recession, the angle of strabismus was corrected to 2.6 ± 0.4 prism diopters per mm (PD/mm) of muscle recession in the case group, and 2.2 ± 0.9 in the control group (P=0.2). For patients who had undergone monocular recession and resection (R&R) for esotropia, the angle of strabismus was corrected 3.4 ± 0.3 PD/mm of muscle recession or resection in the case group, and 3.2 ± 0.2 in the control group (P=0.05). For patients who had undergone bilateral recession, the angle of strabismus was corrected 2.3 ± 0.2 PD/mm of muscle recession in the case group, and 2.2±0.2 in the control group (P=0.03). For patients who had undergone R&R for exotropia, the angle of strabismus was corrected 3.1 ± 0.5 PD/mm of muscle recession or resection in the case group, and 2.7 ± 0.3 in the control group (P=0.02).

Conclusion: Connective tissue ensheathments, whether disturbed or removed, do not ultimately affect the success of the strabismus surgery.     

Clinical Manifestations of Strabismus in Patients with Primary Congenital Glaucoma

Purpose: To determine the clinical manifestations and risk factors of developing strabismus in primary congenital glaucoma (PCG) patients who underwent glaucoma surgery.

Methods: A retrospective case-series study of 54 PCG patients who were followed for at least 3 years after glaucoma surgery. The subjects were divided into 2 groups based on the occurrence of strabismus. Age at glaucoma diagnosis and surgery, visual acuity, intraocular pressure, amblyopia, cup-disc ratio, and orthoptic status were compared between the 2 groups.

Results: Twenty of 54 patients (37.0%) developed strabismus after glaucoma surgery. The mean ages at the time of glaucoma diagnosis and surgery were 3.2 ± 2.7 months and 3.4 ± 2.8 months in the strabismus group and 24.3 ± 19.1 months and 26.4 ± 18.9 months in the non-strabismus group, respectively (p < .05). In addition, the mean logMAR visual acuities were 0.87 ± 0.38 in the strabismus group and 0.24 ± 0.21 in the non-strabismus group (p < .05). The proportion of patients experiencing amblyopia was 90.0% in the strabismus group. Low visual acuity and young age at glaucoma surgery were significant predictors of developing strabismus. Kaplan-Meier survival analysis demonstrated that the probability of developing strabismus after glaucoma surgery was 50.6% at 10 years post-surgery.

Conclusions: PCG patients who developed strabismus after glaucoma surgery were diagnosed with glaucoma and underwent surgery at a younger age, exhibited a worse mean best corrected visual acuity, and exhibited a higher amblyopia incidence than did patients in the non-strabismus group.     

间歇性外斜视患者分型对眼位控制能力的影响

目的:分析间歇性外斜视患者分型对眼位控制能力的影响.方法:选取我院2014-06/2016-07收治的50例行斜视手术治疗的间歇性外斜视患者作为研究对象,依据所有患者视近与视远斜视度数差值将其分为基本型24例(视近斜视角与视远斜视角基本相等或相差≤15△)、分离过强型17例(视远斜视角≥视近斜视角15△)、集合不足型9例(视近斜视角≥视远斜视角15△)三组,采用注视33cm视标(视近)、注视6m视标(视远)、注视户外视标、1h遮盖试验四种检测方法对其眼位控制能力进行比较.结果:基本型间歇性外斜视患者注视33cm视标、注视6m视标、注视户外视标、1h遮盖试验四种检测结果分别为55.10±1.62、45.32±1.21、64.85±1.77、68.33±1.66PD,分离过强型间歇性外斜视患者检测结果为50.23±1.88、67.46±1.17、76.95±1.64、78.15±1.56PD,集合不足型间歇性外斜视患者检测结果为50.98±1.29、33.48±1.40、43.65±1.49、54.64±1.12PD,组间差异具有统计学意义(P＜0.05).结论:间歇性外斜视患者分型对眼位控制能力存在着显著的影响关系,确定其分型将有助于提高斜视手术治疗效果.     

The use of one muscle recession for horizontal strabismus

Purpose

To evaluate the outcomes of one muscle recession for horizontal comitant strabismus at a major referral hospital in the Middle East.

Results of Bilateral Medial Rectus Recession for Comitant Esotropia in Patients with Developmental Delay

Purpose: There is paucity of literature on surgical outcomes after strabismus surgery in patients with developmental delay. There is no consensus regarding whether standard surgical tables are applicable to these children. The goal of our study was to determine results of strabismus surgery for esotropia among these children.

Methods: Two retrospective cohorts of patients, with developmental delay (excluding Down syndrome) and without developmental delay, who underwent bimedial recession for comitant eso-deviation between January 2005 and January 2011, meeting our criteria, were selected. Amount of surgery performed in these children was compared with standard table. This comparison gave us operated angle of deviation. This operated angle of deviation was expressed as percentage of preoperative angle of deviation to get amount of surgery performed. Response to surgery was defined as percentage of change in angle of deviation after surgery to the operated angle of deviation. Amount of surgery performed, response to surgery, and results were compared between two groups.

Results: This study included 25 patients with developmental delay and 53 normal children with comitant esotropia. Age, refractive error, and preoperative angle of deviation were comparable in patients with and without developmental delay. Among patients with developmental delay, on average 72.13%?±?16.08 of angle of deviation was operated; response to surgery gained was 134.06%?±?51.62. In the control group, the average amount of surgery done was 89.08%?±?10.83; response gained was 89.83%?±?22.49. Successful outcome (±10 PD of orthophoria) was noted in 60% patients with developmental delay compared to 73.58% in control group. On average 70.67%?±?17.95 angle of deviation was operated in patients with developmental delay with successful outcome.

Conclusion: Surgical outcome in patients with developmental delay is very unpredictable. An exaggerated response to standard amounts of bimedial recession should be anticipated in these patients. Though there was no statistically significant difference, operating for 70.67%?±?17.95 angle of deviation is more likely to be successful.     

The short adjustable suture

Objective: To describe a new, adjustable suture technique for strabismus surgery that is safe and effective and allows for adjustment during the postoperative week only when required.Design: Retrospective review.Participants: A total of 304 patients, of which 149 were male and 155 female, with an age range from 4 to 89 years and a median age of 42 years.Methods: All patients treated with the short adjustable suture technique between September 2007 and April 2009 were reviewed retrospectively. Details of cause, complexity and reoperation, operative success, requirement for adjustment, and success of adjustment were collected. Success was defined as horizontal deviation ≤ 10 prism diopters (PD) and vertical deviation ≤ 6 PD.Results: Overall, 84% of horizontal deviations and 74% of vertical deviations were treated successfully with 1 operation. Twenty-one adjustments were performed. Complications included 1 slipped slip knot and 6 conjunctival or Tenon cysts.Conclusions: The short adjustable suture is a safe and effective variation of the standard slip-knot adjustable suture technique. It allows for adjustment up to 6 days postoperatively with minimal patient discomfort. When adjustment is not indicated, the suture can be left in place to absorb.     

Intraoperative adjustable suture strabismus surgery under topical and subconjunctival anesthesia

BACKGROUND AND OBJECTIVE: To assess the postoperative surgical results of intraoperative adjustable suture strabismus surgery under topical and subconjunctival anesthesia. PATIENTS AND METHODS: For 44 patients who had undergone intraoperative adjustable suture technique under topical anesthesia, the deviations were measured preoperatively, at 1 day, 1 month, and 3 months postoperatively, and at the last postoperative follow-up visit. The mean follow-up period was 7.8 months. RESULTS: Thirty-three patients had exotropia and 11 had esotropia. Mean age was 28.8 years. The success rates for exotropia and esotropia at the last follow-up visit were 81.8%. CONCLUSION: Intraoperative adjustable suture strabismus surgery under topical and subconjunctival anesthesia is the recommended surgical technique due to the successful results and various advantages compared with non-adjustable surgery, including the decreased rates of overcorrection or undercorrection that appear immediately after surgery and reoperation. Postoperative "drift" toward the original deviation was observed under longer follow-up periods than other studies.     

Tendencias actuales de la cirugía de estrabismo en un hospital terciario

ObjectiveTo analyze the strabismus surgeries and the outcomes during a year and a half in a tertiary hospital.Material and methodsA retrospective study of patients who underwent strabismus surgery. The mean age, sex, diagnosis, diplopia, surgery, anesthesia, adjustable sutures, results, reoperations and follow up time from surgery were analyzed. A good outcome was considered when the final horizontal deviation was less than 10 prism diopters (pd) and the vertical deviation less than 5 pd without diplopia.ResultsA total of 153 cases were operated on, mean age: 43.14 ± 25.58 years (61.4%: women). 74.5% of patients were ≥ 18 years (33.33% ≥ 60). Diplopia was present in 51% of patients. The most frequent deviation was horizontal: 83.6%. The most frequent diagnosis was cranial nerve palsies: 32% (VI nerve: 12.4%), restrictive strabismus: 7.2%, and the aged related distance esotropia: 6.5%. Adjustable sutures were used in 19.7% of cases and topical anesthesia in 65.4%. Good outcomes was present in 79.2% of cases at the end of follow-up. Reoperations were needed in 25.5%. Follow-up evolution time was 11.87 months ± 6.5. The sex female (P = .012) and the oblique superior surgery (P =.017) were associated with bad outcome.ConclusionThe adult strabismus surgery was three times more frequent than the children strabismus surgery. The third of the adults that were operated on were ≥ 60 years. The cranial nerve palsies were the most frequent diagnosis. Adjustable sutures were rarely used. Good outcomes were obtained in most of the patients at the end of follow-up.