Prognostic factors for strabismus surgery after cataract surgery

Long-term outcomes of single monocular resection-recession in adult sensory strabismus and factors affecting the postoperative drift

Purpose

The purpose of our study was to analyze the clinical characteristics and outcome of horizontal strabismus surgery in patients having sensory strabismus and to analyze the factors that affect the postoperative drift in these patients over a follow-up of three years.

Methods

This was a retrospective case series. Patients aged ≥18 years, having low vision (visual acuity ≤20/60) in one eye, and undergoing horizontal strabismus surgery (standard recess-resect procedures) in the same eye were recruited. All patients were advised patching of the good eye six weeks prior and continued for six weeks post strabismus surgery. We excluded patients who had paralytic disorders, motility defects, or those with chronic systemic conditions. Patients with a minimum follow-up of three years were recruited.

Results

The study included 56 patients whose mean age was 22.9 ± 4.93 years. Exotropia (n = 38; 67.8%) was more common than esotropia (n = 18; 32.1%). Preoperative visual acuity was 1.1 ± 0.85 (range perception of light to 6/18p). The cause of low vision was amblyopia (n = 30; 53.5%) followed by trauma (n = 22; 39.2%). The mean preoperative distance deviation was 57.7 ± 15.5 PD in the primary position (range: 20-65 PD). The success rate of exotropia (78.9%) was more than esotropia (52.9%) at three years. Two patients with esotropia were overcorrected. All patients with exotropia showed an exotropic drift with time.

Conclusion

The motor alignment after a single recession-resection procedure was satisfactory at the long-term in our cohort of sensory strabismus. The duration or extent of visual impairment had no relation to the postoperative outcome.

Surgical results and factors affecting outcome in adult patients with sensory exotropia

PURPOSE

To report the results of surgical treatment for sensory exotropia and to examine the factors associated with the surgical outcome.

METHODS

The records of patients with sensory exotropia who were older than 18 years at the time of surgery and were followed up for at least 1 year postoperatively were retrospectively reviewed. Patients with visual acuity of ≤20/100 in the amblyopic eye were enrolled. Surgical success was defined as a final deviation of <10 prism diopters (PD) at distance in the primary position. Preoperative patient characteristics, surgical procedures performed, and early postoperative ocular alignment were evaluated as potential factors associated with the surgical outcome.

RESULTS

A total of 64 patients were included, of whom 40 (62.5%) achieved surgical success, four (6.3%) showed overcorrection, and 20 (31.3%) experienced recurrence over an average follow-up duration of 2.0 ± 1.2 years. Preoperative distant and near angles of deviation were significant factors associated with surgical outcome. Regardless of the high rate of recurrence, initial postoperative large overcorrection did not guarantee a positive result. Instead, presence of initial postoperative esodrift was related to surgical success. Multivariable analysis revealed that only the preoperative distant angle of deviation was significantly associated with surgical outcome.

CONCLUSION

The long-term outcome of surgery for sensory exotropia was satisfactory, and patients with small preoperative distant angle of exodeviation showed more favorable outcome.