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Franco E, Mancioppi S, Forini E, Franco M, Franco F. Phased strabismus surgery under topical anesthesia. Eur J Ophthalmol 2024; 34:89-94. [PMID: 37113014 DOI: 10.1177/11206721231171425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
PURPOSE To evaluate the feasibility and outcomes of phased strabismus surgery under topical anesthesia, with intraoperative comparison of ocular alignment in supine and seated positions. METHODS This retrospective clinical investigation analyzed the data of patients who underwent phased strabismus surgery with fixed sutures under topical anesthesia. The technique consisted of 2 phases, spaced out with an intraoperative alternate prism cover test (performed in supine and seated positions): (1) surgery on one or two muscles, as defined by a preoperative surgical plan; (2) if judged necessary, a further one-muscle surgery. Surgical success was defined as a residual angle of horizontal and vertical deviation ≤±8Δ and ≤5Δ, respectively, and the presence of single binocular vision in primary position in patients with preoperative diplopia. Follow-up visits were scheduled 1 day, 1 month, and 6 months after surgery. RESULTS The review identified 38 patients (age range: 10-80 years). Surgery was well tolerated by all patients. Twelve (32%) required a second phase. No statistically significant differences were found for intraoperative angles of deviation in supine and seated positions. Surgical success was reached, respectively, in 88% and 87% of cases with horizontal and vertical deviation 6 months after surgery. No patients were reoperated during the follow-up period. CONCLUSIONS Phased strabismus surgery is a feasible technique for various types of strabismus in adults and children. Secondly, intraoperative evaluation of ocular alignment can be performed either with the patient seated or supine, with the same accuracy in terms of surgical success.
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Affiliation(s)
- Elena Franco
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy
| | - Silvia Mancioppi
- Operational Unit of Ophthalmology, St. Anna University Hospital of Ferrara, Ferrara, Italy
| | - Elena Forini
- Management Control, St. Anna University Hospital of Ferrara, Ferrara, Italy
| | - Maria Franco
- Division of Pediatrics, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Filippo Franco
- Operational Unit of Ophthalmology, St. Anna University Hospital of Ferrara, Ferrara, Italy
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Nadeem S. Long-term outcomes of adjustable strabismus surgery at a Pakistani university hospital. Int Ophthalmol 2022; 43:825-836. [PMID: 36063247 DOI: 10.1007/s10792-022-02484-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 08/20/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Strabismus, whether congenital or acquired, is a common visual and cosmetic problem, especially for the young. Adjustable suture strabismus surgery is not in vogue in our country. This technique gives the surgeon a second attempt to provide a better outcome for the patients. Our objective was to assess the long-term success of adjustable strabismus surgery in terms of postoperative alignment. METHODS We carried out a prospective study utilizing the fornix approach for adjustable strabismus surgery, in mainly horizontal, but also vertical strabismus in adults and cooperative children, to enhance the postoperative outcomes. The patient characteristics, preoperative deviation, type and pattern of strabismus, were evaluated and analyzed. The postoperative alignment was evaluated at 1 year and beyond, to assess the success of this adjustable surgery. RESULTS This study recruited 50 adults and children with a female predominance of 39 (78%); and with the mean age being 18.34 ± 9.88 years. Exotropia was the primary diagnosis in the majority with 21 (42%) cases; with purely horizontal strabismus in 23 (46%) cases. The mean preoperative horizontal deviation was 48.76 ± 20.35 prism diopters (PD) and the mean postoperative horizontal deviation was 2.73 ± 3.63 PD. The mean preoperative vertical deviation was 4.8 ± 8.54 PD whereas the mean postoperative vertical deviation was 0.86 ± 1.73 PD. The Wilcoxon Signed Ranks test analyzed the difference between the two which was statistically significant (p = 0.000). Surgical success, defined as postoperative horizontal alignment within ≤ 10 PD of orthotropia at the end of one year or more of follow-up after surgery, was achieved in 49 (98%) cases. The average follow-up was 21.47 ± 8.7 months. CONCLUSION Adjustable strabismus surgery has very good long-term outcomes in terms of postoperative alignment and patient satisfaction.
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Affiliation(s)
- Sana Nadeem
- Department of Ophthalmology, Foundation University Islamabad/Fauji Foundation Hospital, Defence Avenue, Phase-I, DHA, 44000, Islamabad, Pakistan.
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Carreño C D, Burgos-Blasco B, Gómez de Liaño R, Dávila T A, Cañizares R, Zúñiga Menéndez J, Carreño C J. Efficacy and safety of adjustable suture in horizontal strabismus: Comparative study of children versus adults. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2022; 97:483-489. [PMID: 35872000 DOI: 10.1016/j.oftale.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 04/05/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Adjustable 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. METHODS Prospective 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. RESULTS 186 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 = 0.044). 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 = 0.043) and remained for 6 months (p < 0.05). Previous surgery (p = 0.004) and exotropia (p = 0.018) correlated with the need for adjustment. CONCLUSIONS 20% 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.
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Affiliation(s)
- D Carreño C
- Hospital del Día Dr. Efrén Jurado López; Instituto Ecuatoriano de Seguridad Social, Guayaquil, Ecuador
| | - B Burgos-Blasco
- Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
| | - R Gómez de Liaño
- Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - A Dávila T
- Instituto Ecuatoriano de Seguridad Social, Guayaquil, Ecuador
| | - R Cañizares
- Universidad Católica Santiago de Guayaquil, Guayaquil, Ecuador
| | | | - J Carreño C
- Ministerio de Salud Pública, Guayaquil, Ecuador
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Natung T, Pandey I, Lyngdoh LA. Outcomes of a simplified, fixed surgical dosage calculation for uncomplicated, horizontal, concomitant strabismus in adults. Indian J Ophthalmol 2022; 70:1321-1326. [PMID: 35326047 PMCID: PMC9240516 DOI: 10.4103/ijo.ijo_2399_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose The aim of this study was to evaluate the outcomes of a simplified, fixed surgical dosage calculation for uncomplicated, horizontal, concomitant strabismus in adults. Methods Outcomes analysis of a fixed-dose calculation method for uncomplicated, horizontal, concomitant strabismus in adults (≥18 years) wherein 1-mm recession/resection equals 2 PD for lateral rectus and 3 PD for medial rectus. This was a retrospective case series. Results The mean age of the patients was 28.50 ± 8.43 years, the mean amount of preoperative deviation was 35.16 ± 9.97 PD, the mean expected correction was 36.26 ± 9.49 PD, and the mean correction achieved was 35.92 ± 10.74 PD. There were 22 monocular exotropias, six monocular esotropias, eight alternate divergent squints, and two alternate convergent squints. There were 20 cases of sensory strabismus (54.28%). There was no statistically significant difference between the expected correction and correction achieved (P = 0.519), meaning that our fixed-dose calculation method was effective. Thirty-five out of 38 patients had successful outcomes as per our criteria of less than 10-PD deviations from straight in primary position. Therefore, the success rate achieved by this procedure was 92.10%. There was no statistically significant correlation between age and the amount of deviation (P = 0.611). Conclusion Our case series had a high postoperative success rate in terms of motor alignment. It is hoped that this simplified, fixed-dosage calculation method would help the numerous novice strabismus surgeons, make their starting steps easier and give them the confidence to do strabismus surgeries. They can modify the dosages later as per their own experiences.
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Affiliation(s)
- Tanie Natung
- Department of Ophthalmology, North Eastern Indira Gandhi Regional Institute of Health and Medical Science (NEIGRIHMS), Shillong, Meghalaya, India
| | - Ishita Pandey
- Department of Ophthalmology, North Eastern Indira Gandhi Regional Institute of Health and Medical Science (NEIGRIHMS), Shillong, Meghalaya, India
| | - Laura A Lyngdoh
- Department of Ophthalmology, North Eastern Indira Gandhi Regional Institute of Health and Medical Science (NEIGRIHMS), Shillong, Meghalaya, India
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Abdelmonem AA, Awadein A, Genidy MMM, Abdelhalim AS, Abdelaziz STA. Early and delayed suture adjustments after adjustable suture strabismus surgery: a randomized controlled trial. MEDICAL HYPOTHESIS, DISCOVERY & INNOVATION OPHTHALMOLOGY JOURNAL 2022; 11:144-150. [PMID: 37641609 PMCID: PMC10460247 DOI: 10.51329/mehdiophthal1458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/24/2022] [Indexed: 08/31/2023]
Abstract
Background Adjustable sutures increase the success rate of strabismus surgery. However, the optimal timing of postoperative suture adjustment remains controversial. This trial was aimed at comparing the surgical outcomes and pain scores of early or 2 - 4 h and delayed or 24 h postoperative suture adjustment in adult patients undergoing strabismus surgery. Methods An open-label, prospective, randomized, comparative interventional study was performed in consecutive adult patients scheduled for eye muscle surgery. Patients were randomized into two groups: the early group, with suture adjustment 2 - 4 h postoperatively, and the delayed group, with suture adjustment 24 h postoperatively. Subjective pain scores during the adjustment were also analyzed. The angles of misalignment at 1 and 3 months and the success rate at 3 months postoperatively were compared. Results Forty-five (90%) patients completed the follow-up, including 23 (92%) in the early adjustment group and 22 (88%) in the delayed adjustment group, with a mean (standard deviation) age of 25.6 (9.5) years and a male-to-female ratio of 46.7:53.3. Thirty patients (66.7%) had exotropia, and 15 (33.3%) patients had esotropia. Both groups had comparable baseline characteristics (all P > 0.05). The mean pain scores during adjustment did not differ significantly between groups (P > 0.05). The postoperative angles of alignment were comparable between the groups before suture adjustment and at the 1- and 3-month follow-ups (all P > 0.05). The success rate in the early adjustment group was slightly higher (87.0% versus 63.6%), but the difference was not statistically significant (P > 0.05). The success rate was comparable between the groups in patients with esotropia or exotropia (both P > 0.05). Conclusions Although the early adjustment group had a slightly higher success rate, the difference was not significant. Both groups had comparable subjective pain scores during adjustment, final motor alignment, or success rate. Future clinical trials should be performed different time intervals for postoperative suture adjustment, and subjective and objective outcomes, such as diplopia and stereopsis, should be compared between patients with a first strabismus surgery and those who underwent reoperation. This could better resolve the persistent controversy related to the optimal time for suture adjustment.
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Affiliation(s)
| | - Ahmed Awadein
- Ophthalmology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Elkamshoushy A, Kassem A. Stepped Strabismus Surgery. Clin Ophthalmol 2021; 15:1783-1789. [PMID: 33953537 PMCID: PMC8090981 DOI: 10.2147/opth.s304798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 04/09/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose To present stepped strabismus surgery as a novel technique in cases of small to moderate angle strabismus. Methods Retrospective chart review of cases of stepped strabismus surgery from 2010 untill 2018. In stepped surgery, the first muscle is operated on under rapid induction-recovery IV propofol infusion. Patient is assessed in the OR. If deemed necessary, other muscles are operated on under general anesthesia. No adjustable sutures are used. Results The technique was used in 22 cases of superior oblique palsy (SOP) (primary position hypertropia in the range of 12–25 prism diopters) and 29 horizontal strabismus cases (angles in the range 12–20 prism diopters). The first step was an inferior oblique myectomy in the SOP cases and a single rectus recession in the horizontal cases. After intraoperative assessment, 31% (16/51) needed additional muscle surgery. After 6 months of follow up, the overall reoperation rate was 9%. The technique was well tolerated by all patients. Conclusion Stepped strabismus surgery is a useful technique for small to moderate angle strabismus cases with the potential for reducing the number of extraocular muscles operated on without compromising the surgical outcome.
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Affiliation(s)
- Amr Elkamshoushy
- Department of Ophthalmology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Ahmed Kassem
- Department of Ophthalmology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
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