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Hüseyinhan Z, Gürez C, Ülgen Y. How to reduce conjunctival cyst formation after strabismus surgery? Strabismus 2023; 31:166-171. [PMID: 37581336 DOI: 10.1080/09273972.2023.2242428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
PURPOSE To determine our rate of conjunctival cyst developing after strabismus surgery and to minimize its formation. MATERIALS AND METHODS The data of 4026 eyes of 2662 patients were included in our retrospective analysis of, those that underwent strabismus surgery at the Beyoğlu Eye Training and Research Hospital Strabismus Unit between 2015 and 2021. Clinical characteristics and follow-up data of patients were recorded together with age, sex, and operation type. All patients were examined postoperatively on 1st day, 1st month and 6th month. RESULTS The mean age of the patients was 15.66 ± 11.81 (1-59 years). While two eyes were operated on in 1494 patients, one eye was operated on in 1168 patients. The surgeries performed were recession and/or resection of the horizontal and vertical rectus muscles and inferior and superior oblique procedures. The conjunctival cyst was detected in 11 patients postoperatively between 20 days and 8 months. The cyst was detected on the nasal side in 7 cases and temporal in 4. CONCLUSION Conjunctival cyst is a rare complication after strabismus surgery and it is thought to be caused by a proliferation of the conjunctival epithelium. In addition to proper closure of the conjunctiva, attention to personal hygiene, avoidance of contacts that may increase suture contamination, and attention to the fact that the operation period is not long are actions that can help prevent conjunctival cyst formation.
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Affiliation(s)
- Zahid Hüseyinhan
- University of Health Sciences Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey
| | - Ceren Gürez
- University of Health Sciences Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey
| | - Yiğit Ülgen
- University of Health Sciences Bağcılar Training and Research Hospital, Istanbul, Turkey
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Venincasa MJ, Shoji MK, Al-Khersan H, Maeng MM, Johnson TE, Flynn HW. Acute Onset Endophthalmitis Following Bilateral Upper and Lower Eyelid Blepharoplasty. Ophthalmic Plast Reconstr Surg 2022; 38:e131-e133. [PMID: 35470337 DOI: 10.1097/iop.0000000000002176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 59-year-old woman presented with iritis and uveitis in the OD approximately 3 weeks after she underwent a bilateral upper and lower blepharoplasty by an outside oculoplastic specialist. Examination revealed a visual acuity of hand motion in the OD, scleral ulceration suspicious for prior globe perforation, dense vitritis, and loculations and membranes on echography. The patient was diagnosed with acute onset exogenous endophthalmitis. Vitreous aspiration and intravitreal injection of vancomycin and ceftazidime were performed. The patient underwent a pars plana vitrectomy, and vitreous culture demonstrated Streptococcus pseudoporcinus . Postoperative vision improved to 4/200 but was limited by a full-thickness macular hole. Despite silicone oil removal and macular hole repair, the macular hole remained open at month 7 and limited vision to 5/200. During eyelid surgery, surgeons should take precautions against intraoperative needle perforation including possible use of protective shield. Postoperative vision loss after eyelid surgery requires further evaluation.
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Affiliation(s)
- Michael J Venincasa
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
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Hashim I, Al-Haddad C. Scleral Perforation as a Complication of Strabismus Surgery: A Literature Review. J Pediatr Ophthalmol Strabismus 2022; 59:214-223. [PMID: 34928765 DOI: 10.3928/01913913-20211019-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of this review was to report the existing literature on the incidence, risk factors, treatment, and outcomes of scleral perforation as a vision-threatening complication of strabismus surgery. The current literature reported an incidence range of scleral perforation/penetration between 3 in 1,000 and 7.8%. Rectus muscle recession was the most commonly mentioned risk factor among the studies. Other risk factors were myopia, previous extraocular muscle surgery, surgeon experience, S-24 needle use, muscle reattachment posterior to the original insertion site, operating on a horizontal rectus muscle, and young age. Different views existed in the literature regarding scleral perforation management. Some ophthalmologists advocated management by cryopexy or indirect ophthalmoscopic laser uniformly, whereas others reserved it for more complicated cases. Antibiotic therapy for endophthalmitis prophylaxis was recommended by one study and shown to be practiced by some ophthalmologists. [J Pediatr Ophthalmol Strabismus. 2022;59(4):214-223.].
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Heo H, Ryu WY, Chandramohan A, Lambert SR. Incidence of infectious complications following strabismus surgery. J AAPOS 2022; 26:158-160. [PMID: 35436601 PMCID: PMC9250602 DOI: 10.1016/j.jaapos.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/13/2022] [Accepted: 01/23/2022] [Indexed: 11/15/2022]
Abstract
A total of 167 cases (0.111%) of infectious complications (endophthalmitis, orbital cellulitis, preseptal cellulitis, and postoperative infection) were identified in patients after strabismus surgery. The incidence of postoperative endophthalmitis was approximately 1 per 13,700 strabismus surgeries (0.007%) among 151,011 strabismus surgeries in US claims databases.
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Affiliation(s)
- Hwan Heo
- Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California; Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Won Yeol Ryu
- Department of Ophthalmology, Dong-A University College of Medicine, Busan, South Korea
| | - Arthika Chandramohan
- Department of Ophthalmology, Kaiser Permanente Southern California, San Diego, California
| | - Scott R Lambert
- Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California.
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Wright KW, Arow M, Zein M, Strube YNJ. Wright hang-back recession with fibrin glue compared with standard fixed suture recession for the treatment of horizontal strabismus. Can J Ophthalmol 2020; 56:244-249. [PMID: 33358991 DOI: 10.1016/j.jcjo.2020.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/12/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the clinical safety and efficacy of the novel Wright hang-back recession with fibrin glue for the treatment of horizontal strabismus. STUDY DESIGN Retrospective, case-controlled clinical study comparing surgical outcomes of the Wright hang-back rectus recession with fibrin glue (WHBG) versus standard fixed suture rectus recession (SFR). METHODS Medical records of all patients who underwent strabismus surgery by one strabismus surgeon between 2016 and 2018 for horizontal deviations only, including cases of WHBG (group 1) or SFR (group 2), were reviewed. Good surgical outcome was defined as a postoperative deviation ≤10 prism diopters (PD) at a minimum 2 months of follow-up. RESULTS 32 eyes of 17 patients underwent WHBG and 32 eyes of 17 patients underwent SFR; in each group, 35% had esotropia and 65% had exotropia. Mean preoperative deviations between groups were similar: esotropia 25.5 PD and exotropia 26.6 PD in WHBG; esotropia 28.3 PD and exotropia 23.8 PD in SFR. The mean postoperative deviation was <7 PD for both groups. Good surgical outcomes were similar between groups, 16/17 (94%) in WHBG and 15/17 (88%) in SFR, with no complications. CONCLUSIONS WHBG was safe and effective with postoperative results similar to SFR. WHBG has an important advantage, eliminating the complication of retinal perforation that can occur with SFR while avoiding under- or overcorrection that can occur with traditional hang-back recession. This technique increases patient safety without sacrificing surgical outcomes and is especially useful in patients with thin sclera such as patients with high myopia or with difficult posterior exposure.
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Affiliation(s)
- Kenneth W Wright
- Wright Foundation for Pediatric Ophthalmology and Strabismus, Los Angeles, CA, USA
| | - Majd Arow
- Wright Foundation for Pediatric Ophthalmology and Strabismus, Los Angeles, CA, USA
| | - Mike Zein
- Bascom Palmer Eye Institute, Miami, FL, USA
| | - Yi Ning J Strube
- Bascom Palmer Eye Institute, Miami, FL, USA; Department of Ophthalmology, Queen's University and Kingston Health Sciences Centre, Kingston, Ont, Canada.
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Wright KW, Corradetti G, Strube YNJ, Mai SV. Foreign body extrusion associated with N-butyl-2-cyanoacrylate glue used with rectus muscle hang-back recession. Can J Ophthalmol 2020; 55:58-62. [DOI: 10.1016/j.jcjo.2019.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/27/2019] [Accepted: 07/05/2019] [Indexed: 11/26/2022]
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Dagi LR, Velez FG, Archer SM, Atalay HT, Campolattaro BN, Holmes JM, Kerr NC, Kushner BJ, Mackinnon SE, Paysse EA, Pihlblad MS, Pineles SL, Strominger MB, Stager DR, Stager D, Capo H. Adult Strabismus Preferred Practice Pattern®. Ophthalmology 2020; 127:P182-P298. [DOI: 10.1016/j.ophtha.2019.09.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 09/20/2019] [Indexed: 11/25/2022] Open
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DeBenedictis CN, Yassin SH, Gunton K, Nelson LB, Leiby BE, Hegarty SE, Schnall B. Strabismus Surgery Infection Prophylaxis and Timing of First Postoperative Visit. J Pediatr Ophthalmol Strabismus 2019; 56:354-359. [PMID: 31743402 DOI: 10.3928/01913913-20190808-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/07/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To characterize the practice patterns of pediatric ophthalmologists regarding infection prophylaxis for strabismus surgery and timing of the first postoperative visit. METHODS A ten-question multiple-choice, close-ended questionnaire was e-mailed to members of the American Association for Pediatric Ophthalmology and Strabismus listserv. Survey responses were summarized using frequencies and percentages. Univariable tests of association between prophylactic measures and surgeons reporting a prior episode of postoperative cellulitis or endophthalmitis were performed. RESULTS Three hundred eighty pediatric ophthalmologists completed the survey. Most ophthalmologists instill 5% povidone-iodine solution during surgical preparation (88.4%), use topical antibiotics with or without steroids at the conclusion of surgery (90%), and prescribe oral or topical antibiotics postoperatively (85.5%). Eighty-five percent of strabismus surgeons routinely see patients for the first postoperative visit within the first week, although there is no consensus as to which day is preferred. Responders previously reporting experience with a postoperative infection were more likely to use intraoperative intravenous antibiotics (P = .002) and Tegaderm tape (3M, St. Paul, MN) or other adhesive drape to isolate the eyelids/eyelashes (P = .047). CONCLUSIONS A common practice pattern appears to exist regarding the use of 5% povidone-iodine solution in surgical preparation, application of topical antibiotics at the end of surgery, and a postoperative regimen of topical antibiotics/steroids. There is no prevailing practice pattern regarding the timing of the first postoperative visit. Previous experience with postoperative cellulitis or endophthalmitis may lead to the adoption of more formidable infection prophylaxis measures such as intravenous antibiotics prior to surgery. [J Pediatr Ophthalmol Strabismus. 2019;56(6):354-359.].
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Ing MR, Shortell J, Golez J. Extraocular and Intraocular Infections Following Strabismus Surgery: A Review. J Pediatr Ophthalmol Strabismus 2019; 56:214-221. [PMID: 31322710 DOI: 10.3928/01913913-20190425-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 04/15/2019] [Indexed: 11/20/2022]
Abstract
An extensive literature review of various types of infections following strabismus surgery was facilitated by using the search engines PubMed and Google Scholar. In both search engines, the phrases "infection following strabismus surgery," "infection strabismus surgery," "complications of strabismus surgery," "endophthalmitis strabismus surgery," and "strabismus scleral perforation" were used for the review. The type of infection, surface involved, and site of the infection determined the type of therapy. Infections involving deeper tissues, such as periocular infection or orbital cellulitis, required systemic therapy. Sub-Tenon's abscesses required incision and drainage, as well as systemic antibiotics. The development of endophthalmitis following strabismus surgery was rare, but was usually devastating to the visual result. Symptoms of an adverse intraocular condition began by mean postoperative day 3, but the definitive diagnosis and treatment of endophthalmitis was not made until mean postoperative day 6. Despite early detection of this latter type of infection and early surgical intervention with vitreous paracentesis and intraocular injection of antibiotics, the visual result was extremely poor in more than two-thirds of the reported cases. Although there is no known way to truly prevent all infections following strabismus surgery, several techniques may be prudent for the strabismus surgeon to adopt to decrease the bacterial load and minimize the risk of infection. The surgeon should be encouraged to consider preoperative use of povidone-iodine on the operative field and avoid scleral perforation during surgery. [J Pediatr Ophthalmol Strabismus. 2019;56(4):214-221.].
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Phuljhele S, Saxena R, Sharma P, Saini M. Complications of Strabismus Surgery. Strabismus 2019. [DOI: 10.1007/978-981-13-1126-0_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Zloto O, Mezer E, Ospina L, Stankovic B, Wygnanski-Jaffe T. Endophthalmitis Following Strabismus Surgery: IPOSC Global Study. Curr Eye Res 2017; 42:1719-1724. [PMID: 28925741 DOI: 10.1080/02713683.2017.1351569] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To examine the characteristics of patients with endophthalmitis after strabismus surgery (PSSE), the characteristics of the strabismus surgery, treatment, and prognosis as reported by pediatric ophthalmologists who are members of the American Association for Pediatric Ophthalmology and Strabismus (AAOPS) around the world. METHODS An email communication was sent to all members of AAPOS. The email included a web link to a survey that included 34 questions that examined the characteristics of patients with endophthalmitis after strabismus surgery. RESULTS Three hundred forty-nine ophthalmologists responded to the questionnaire. Two hundred sixty four (76%) had practiced pediatric ophthalmology for over 10 years. Twenty-seven cases of endophthalmitis were reported. The medial rectus muscle (MR) was the most common muscle undergoing surgery (55%). In 5 patients (21%), perforation was observed at the time of surgery. In all cases, endophthalmitis was diagnosed 3-7 days after surgery. The final visual acuity of 34% was no light perception (NLP). DISCUSSION This series is the largest existing series on PSSE. Our data suggest that PSSE can occur also in healthy patients and in patients without a visualized scleral perforation. The majority of PSSE occurs during the first week after surgery. Therefore, we believe that all patients that underwent strabismus surgery should be examined in this time frame. The prognosis was poor with 48% demonstrating a visual acuity of LP or NLP at the final follow-up.
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Affiliation(s)
- Ofira Zloto
- a Goldschleger Eye Institute , Sheba Medical Center, Tel Hashomer, Israel.,b Sackler Faculty of Medicine , Tel-Aviv University , Tel Aviv , Israel
| | - Eedy Mezer
- c Department of Ophthalmology, Ruth Rappaport Children's Hospital , Rambam Health Care Campus, Haifa, Israel.,d Bruce Rappaport Faculty of Medicine, Technion , Israel Institute of Technology , I.I.T ., Haifa , Israel
| | - Luis Ospina
- e Ophthalmology Department, Sainte-Justine's Hospital , University of Montreal , Montreal , Canada.,f Ophthalmology Department, Notre-Dame Hospital , University of Montreal , Montreal , Canada
| | - Branislav Stankovic
- g Faculty of Medicine , University of Belgrade , Serbia.,h Institute of Ophthalmology , Clinical Centre of Serbia , Belgrade , Serbia
| | - Tamara Wygnanski-Jaffe
- a Goldschleger Eye Institute , Sheba Medical Center, Tel Hashomer, Israel.,b Sackler Faculty of Medicine , Tel-Aviv University , Tel Aviv , Israel
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Patel SB, Reddy N, Hogan RN, Cao JH. A Case of Endophthalmitis After Bilateral Medial Rectus Recession. J Pediatr Ophthalmol Strabismus 2017; 54:e37-e41. [PMID: 28665442 DOI: 10.3928/01913913-20170531-07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 05/26/2017] [Indexed: 11/20/2022]
Abstract
A 9-month-old male infant with a history of Down syndrome underwent bilateral medial rectus recession. Two weeks postoperatively, he developed leukocoria of the left eye with a white opacity posterior to the lens, numerous undulations, necrosis, and hemorrhages in the retrolental space. His contralateral eye had white retinal lesions nasally. Ultrasound examination of the left eye showed a funnel retinal detachment, loculated debris, and a small, central, hyperechoic area concerning for calcification. He underwent enucleation because retinoblastoma could not be definitively ruled out. Given this patient's low visual potential, enucleation was a definitive and safe treatment option. Ocular pathology showed significant inflammation and necrosis. There was an area of scleral perforation by a suture adherent to the retina and vitreous, surrounded by inflammatory cells. This case uniquely demonstrates pediatric endophthalmitis following strabismus surgery, secondary to scleral perforation confirmed by histopathological analysis. Care must be taken during scleral passage of sutures to prevent inadvertent scleral perforation and the potential complication of endophthalmitis. [J Pediatr Ophthalmol Strabismus. 2017;54:e37-e41.].
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Successfully managed endophthalmitis following strabismus surgery. J AAPOS 2016; 20:263-6. [PMID: 27312966 DOI: 10.1016/j.jaapos.2016.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 01/09/2016] [Accepted: 01/15/2016] [Indexed: 11/22/2022]
Abstract
Endophthalmitis following strabismus surgery is rare and has been reported to occur in from 1:3,500 to 1:185,000 cases. Severe adverse sequelae, including phthisis bulbi and enucleation, occur often despite early and aggressive treatment. This report describes 3 patients with endophthalmitis following apparently uneventful strabismus surgery by three different surgeons. Infections were aggressively treated. Two patients received intravitreal steroids; all 3 returned to their preoperative baseline visual acuity.
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Endophthalmitis today: a multispecialty ophthalmology department perspective. Eur J Ophthalmol 2015; 26:71-7. [PMID: 26109016 DOI: 10.5301/ejo.5000642] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To portray the current scene of endophthalmitis in a multispecialty ophthalmology department regarding etiologies and treatment guidelines. METHODS Retrospective chart review of all patients diagnosed with endophthalmitis or suspected endophthalmitis from 2009 to 2012. RESULTS A total of 24 eyes were diagnosed with endophthalmitis or suspected endophthalmitis during a 4-year period. The etiologies included endogenous endophthalmitis (6), blebitis (3), Ahmed valve implantation (3, 2 of them with late infection), postcataract surgery (3), intravitreal injections (4), penetrating injury (2), and other surgical procedures (3). Of the postcataract surgery cases, 1 was a congenital cataract surgery, and 2 were referrals. There were no endophthalmitis cases in 4603 adults undergoing cataract surgery in our department during this period. There were 14 positive cultures: 1 was candida and the rest bacteria. Ten of the bacteria cases were Gram-positive cocci (predominantly strep species), 3 were Gram-negative, and coagulase negative staphylococci were detected in 2 cases. CONCLUSIONS Our study indicates a significant change in the case mix of endophthalmitis. The past leading cause, cataract surgery, was dramatically reduced, and intravitreal injections became a major cause. The change in etiologies, and possibly in the microbial flora, warrants reconsideration of the rules that guided the management of endophthalmitis since the Endophthalmitis Vitrectomy Study.
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Abstract
PURPOSE To perform a systematic review of the complications of strabismus surgery, focusing on incidence and risk factors. MATERIAL AND METHODS A systematic literature search was performed using the Medline and Cochrane databases. RESULTS Local complications, such as conjunctival injection and mild scarring, are almost universal but only rarely have long-term clinical significance. There are several important complications that are uncommon but associated with significant long-term sequelae, including slipped muscles, lost muscles, stretched scars, incarcerated muscles, pulled-in-two syndrome, periocular infections, orbital cellulitis, scleral perforations, retinal detachments, endophthalmitis, anterior segment ischemia, and surgical errors. DISCUSSION Strabismus surgery is associated with a number of common and serious complications, and it is important for both surgeons and patients to be aware of the risks.
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Affiliation(s)
- Michael J Wan
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School , Boston, Massachusetts , USA
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Bradbury JA. What information can we give to the patient about the risks of strabismus surgery. Eye (Lond) 2015; 29:252-7. [PMID: 25572582 PMCID: PMC4330301 DOI: 10.1038/eye.2014.316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 12/01/2014] [Indexed: 11/08/2022] Open
Abstract
I hope to report the type, incidence, and clinical outcomes of severe complications from strabismus surgery in the United Kingdom and to help in the discussions involved in the consent process. The main part of the talk will revolve around a BOSU (British Ophthalmic Survey Unit) investigation. Cases were identified prospectively between 1 September 2008 and 31 August 2010. Questionnaire data were requested at the time of the complication recognition and at 6 months' follow-up. Outcome was graded I-V, with a poor or very poor outcome meaning either loss of corrected visual acuity or primary position double vision. A total of 60 completed reports of adverse events and complications were received during the study period. During the same time, ∼24 000 strabismus surgeries were carried out in the United Kingdom, yielding an overall incidence of 1 in 400 operations (95% binomial confidence, 1 per 333-500 operations). The most commonly reported complication was perforation of the globe (19 (0.08%)), followed by a suspected slipped muscle (16 (0.067%)), severe infection (14 (0.06%)), scleritis (6 (0.02%)), and lost muscle (5 (0.02%)). Overall, complications were reported in adults and children in equal numbers; however, scleritis was significantly more common in adults. A poor or very poor clinical outcome was recorded as 1 operation per 2400. The study limitations are as follows: the denominator was extrapolated from the number of surgeries in England, and there was an almost certain underreporting of cases. Complications with the potential for a poor outcome are relatively common, but the final clinical outcome is good in the majority of cases.
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Affiliation(s)
- J A Bradbury
- Eye Department, Bradford Royal Infirmary, Bradford, West Yorkshire, UK
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Benson CE, Rogers KL, Suh DW. Dual application versus single application of povidone-iodine in reducing surgical site contamination during strabismus surgery. J AAPOS 2014; 18:347-50. [PMID: 25173897 DOI: 10.1016/j.jaapos.2014.02.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 02/22/2014] [Accepted: 02/24/2014] [Indexed: 11/18/2022]
Abstract
PURPOSE To investigate the contamination rates in patients undergoing strabismus surgery who received a single versus a dual application of povidone-iodine. METHODS Patients undergoing strabismus surgery were divided into two groups of approximately equal size. Prior to surgery, the surgical sites for both groups were prepared by applying 4 drops of povidone-iodine 5% directly into the conjunctival fornices, after which the eyelashes were cleaned with cotton tips soaked with povidone-iodine 5%. Sterile gauze pads soaked with povidone-iodine 5% were used to clean the periocular skin. After lid speculum placement, the patients in the dual application group received an additional 2 drops of povidone-iodine in the conjunctival fornices. Intraoperatively, the conjunctiva, sclera, needles/sutures, and lid speculum were cultured. Gram stain and cultures were obtained and quantified. Contamination was defined as any bacterial growth on blood agar plates at 2 days. RESULTS A total of 104 patients (aged 7 months to 79 years) were included. The single application group had a 25% contamination rate of surgical site and sutures; the dual application group, a 10% contamination rate. This difference was statistically significant (P = 0.03). The rate of eyelid speculum contamination was unaffected by additional applications (12.5% contamination rate in both groups [P = 0.5]). The additional application of povidone-iodine affected the contamination rate of the conjunctival incision site the most, with a decrease from 20.5% to 5% (P = 0.02). CONCLUSIONS In our study cohort a second application of povidone-iodine significantly decreased the rate of contamination of the surgical site and sutures. It did not affect contamination of the lid speculum.
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Affiliation(s)
- Christy E Benson
- The Wolfe Eye Clinic, Truhlsen Eye Center, The University of Nebraska Medical Center, Omaha, Nebraska.
| | - Kathy L Rogers
- The Wolfe Eye Clinic, Truhlsen Eye Center, The University of Nebraska Medical Center, Omaha, Nebraska
| | - Donny W Suh
- The Wolfe Eye Clinic, Truhlsen Eye Center, The University of Nebraska Medical Center, Omaha, Nebraska
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Khan S, Athwal L, Zarbin M, Bhagat N. Pediatric infectious endophthalmitis: a review. J Pediatr Ophthalmol Strabismus 2014; 51:140-53. [PMID: 24877526 DOI: 10.3928/01913913-20140507-01] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 03/13/2014] [Indexed: 12/28/2022]
Abstract
Infectious endophthalmitis is a rare but severe complication of septecemia, intraocular surgeries, or penetrating eye trauma. The etiology, prognosis, and management of pediatric endophthalmitis resulting from exogenous and endogenous infections are reviewed. Open-globe trauma and glaucoma surgery are the most frequent causes of endophthalmitis in children, whereas endogenous infection is the least common cause. Streptococcus and Staphylococcus species are common bacterial agents in both posttraumatic and postoperative pediatric endophthalmitis, whereas Candida albicans is a commonly reported organism in endogenous endophthalmitis. Additionally, Streptococcus pneumoniae and Haemophilus influenzae appear more likely as pathogens in children than in adults. The clinical manifestations and outcome usually correlate with the virulence of the infecting organism. The visual prognosis of endophthalmitis is generally poor.
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Bloomberg JD, Wang G, Suh DW. Bacterial Species and Surgical Sites Involved in Contamination During Strabismus Surgery. ASIA-PACIFIC JOURNAL OF OPHTHALMOLOGY (PHILADELPHIA, PA.) 2013; 2:169-72. [PMID: 26108109 DOI: 10.1097/apo.0b013e31829a3451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Residual bacterial colonization of the eye after strabismus surgery is common. This study aimed to identify the bacterial pathogens and contaminated sites involved during strabismus surgery. DESIGN A prospective, case-control study of 44 patients aged 1-78 years who underwent strabismus surgery. METHODS Before participation, we received clinical research board approval, and informed consent was obtained from each of the patients or the parents. Five percent povidone-iodine was used to sterilize the surgical site in all cases. Intraoperative swabs were taken from conjunctival incision site, plain gut suture, scleral surgery site, Vicryl suture, and lid specula. Bacteria isolates were identified by culture growth and Gram staining. Positive and negative control samples were collected. RESULTS Samples from 13 (29.5%) of 44 cases were positive for growth of bacteria. The conjunctival incision site was involved in 9 cases (20.5%), and the lid speculum in 7 cases (15.9%). All 13 colonized plates grew the coagulase-negative Staphylococcus strain. Staphylococcus aureus was cultured in 1 case (2.3%) and was associated with the only case of postoperative infection. The S. aureus cultures came from both the conjunctival incision site and the lid speculum. CONCLUSIONS Despite a high contamination rate of 29.5%, incidence of clinically significant infection was low. Our study suggests involvement of the eyelids and conjunctiva in harboring bacteria even after the use of povidone-iodine. Regardless of the mechanism of contamination, we should continue to focus our efforts on reducing intraoperative conjunctival bacterial load. Irregular tear film can contribute to postoperative complications.
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Affiliation(s)
- Justin D Bloomberg
- From the *Des Moines University Medical School, Des Moines, IA; †Bronx-Lebanon Medical Center, New York City, NY; and ‡University of Nebraska Medical Center, Omaha, NE
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Hwang CK, Phoenix VP, Hutchinson AK. Preferences of pediatric ophthalmologists and vitreoretinal surgeons of the treatment of scleral perforations during strabismus surgery. J Pediatr Ophthalmol Strabismus 2011; 48:232-7. [PMID: 20669881 DOI: 10.3928/01913913-20100719-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Accepted: 05/12/2010] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the preferences of pediatric ophthalmologists and vitreoretinal surgeons with regard to the initial management of scleral perforation during strabismus surgery and to determine whether they perceived one mode of treatment conferred a significant advantage over another in terms of the complication rate. METHODS Six hundred sixty-five pediatric ophthalmologists and 494 vitreoretinal surgeons registered with their respective national organizations were invited by an e-mail to respond to an anonymous, web-based survey. The responses to the survey were compared between groups. RESULTS A total of 169 ophthalmologists participated, 133 of whom were pediatric ophthalmologists and 36 vitreoretinal surgeons. Significantly more pediatric ophthalmologists than vitreoretinal surgeons recommend initially managing scleral perforation by observation (P = .001). Among pediatric ophthalmologists, method of treatment was not perceived to affect outcome (P = .75). However, laser photocoagulation was perceived to result in the best outcome among vitreoretinal surgeons (P = .03). CONCLUSION Significant differences exist among pediatric ophthalmologist and vitreoretinal surgeon management preferences and perceived treatment outcomes for scleral perforation.
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Affiliation(s)
- Christopher K Hwang
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia 30322, USA
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Rathod D, Goyal R, Watts P. A Survey of the Management of Globe Perforation During Strabismus Surgery in the United Kingdom. Strabismus 2011; 19:63-6. [DOI: 10.3109/09273972.2011.578298] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Rogers DL, Chheda L, Ford C, Marcon M, Fellows RR, Rogers GL, Bremer DL, McGregor ML, Golden RP, Cassady CB. The effect of surgical preparation technique on the bacterial load of surgical needles and suture material used during strabismus surgery. J AAPOS 2011; 15:230-3. [PMID: 21665501 DOI: 10.1016/j.jaapos.2011.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Revised: 01/11/2011] [Accepted: 03/02/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate the effectiveness of 3 surgical preparation techniques in decreasing bacterial contamination of needles and suture material during strabismus surgery. METHODS Consecutive patients requiring 2-muscle strabismus surgery were randomized into 1 of 3 groups. In Group A, patients' periocular skin and bulbar conjunctivae underwent preparation with 5% povidone-iodine; the drape was placed without regard to eyebrows; and an open wire-loop lid speculum was used. Group B patients underwent the same preparation as Group A patients; however, the eyelashes and eyebrows were scrubbed with 5% povidone-iodine on cotton tip applicators, and the drape was placed to exclude the eyebrows from the surgical field. Group C patients underwent the same preparation as Group B patients; however, a bladed lid speculum was used during surgery to exclude some of the eyelashes from the surgical field. After the procedure, all needles and suture materials were sent separately for aerobic culture. The data were analyzed for differences in contamination rates between the groups. RESULTS Of 77 patients, 24 (31.4%) had either a needle and/or suture contaminant. Groups A, B, and C had mean contamination rates of 29.6%, 34.6%, and 29.2%, respectively. There was no significant statistical variation in contamination among the 3 groups. The most common organism identified was a coagulase-negative staphylococcus strain. CONCLUSIONS More meticulous sterile preparation of the surgical field did not result in a meaningful reduction in suture or needle contamination rates during strabismus surgery.
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Affiliation(s)
- David L Rogers
- Department of Ophthalmology, Nationwide Children's Hospital, Columbus, Ohio 43205, USA.
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Bagheri A, Erfanian-Salim R, Ahmadieh H, Nourinia R, Safarian O, Yazdani S. Globe perforation during strabismus surgery in an animal model: Treatment versus observation. J AAPOS 2011; 15:144-7. [PMID: 21596292 DOI: 10.1016/j.jaapos.2010.12.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 12/22/2010] [Accepted: 12/31/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the role of cryopexy or laser therapy versus observation for management of accidental globe perforation during strabismus surgery in an experimental animal model. METHODS An S-24 needle was passed through the sclera and into the vitreous cavity in both eyes of 42 rabbits. Cryopexy was performed in 22 eyes, and laser therapy was applied in 20 other eyes; the 42 untreated fellow eyes served as controls. The incidence of complications was compared between treated and untreated eyes. RESULTS Cataracts were observed in 7 eyes (8.3%) and corneal opacity in 1 eye (1.2%) vitreous hemorrhage occurred in 28 eyes (33.3%), leading to vitreous opacity in 1 eye (1.2%). Transient localized subretinal fluid accumulation around the retinal break developed in 1 eye (1.2%). There were no cases of endophthalmitis or retinal detachment. There was no significant difference in the rate of complications among the 3 groups. CONCLUSIONS Vision-threatening consequences of globe perforation during strabismus surgery were uncommon in this rabbit model. Simple observation without intervention may have similar results as prophylactic cryopexy or laser therapy.
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Affiliation(s)
- Abbas Bagheri
- Ophthalmic Research Center and Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Huang S, Crawford JB, Rutar T. Pathological findings in poststrabismus surgery endophthalmitis. J AAPOS 2011; 15:98-100. [PMID: 21397817 DOI: 10.1016/j.jaapos.2010.11.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 11/23/2010] [Accepted: 11/24/2010] [Indexed: 10/18/2022]
Abstract
Bacterial entry into the vitreous cavity via inadvertent scleral perforation is one postulated mechanism for poststrabismus surgery endophthalmitis. In a review of 746 cases, we identified 2 pediatric enucleation specimens related to complications of strabismus surgery. In both cases, the patients developed postoperative endophthalmitis and no light perception vision, and the eyes were enucleated when they became phthisical or painful. In both submitted cases, pathology showed a thick band of scar tissue emanating focally from the sclera into the vitreous. Although no needle tracts were visualized, pathological findings were consistent with scleral perforation.
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Affiliation(s)
- Susan Huang
- University of California San Francisco, San Francisco, CA 94143-0730, USA
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Abstract
PURPOSE The purpose of this study is to describe the first reported case of a subretinal abscess after strabismus surgery and the successful treatment with vitrectomy, intravitreal antibiotics, and cryotherapy. METHODS This is a retrospective case report and literature review. RESULTS A 4-year-old boy underwent uncomplicated bilateral medial rectus muscle recession. Within 9 days after surgery, he developed unilateral endophthalmitis with a subretinal abscess at the approximate location of the medial rectus muscle insertion. The rectus muscle-scleral suture was removed, and transscleral cryotherapy was applied to the abscess site. Vitrectomy with injection of intravitreal antibiotics was performed. A bacterial culture of the removed suture was positive for Staphylococcus aureus and sensitive to his antibiotics. By 1 month, the abscess and vitritis had resolved completely. CONCLUSION This is the first reported case of endophthalmitis with a subretinal abscess occurring after strabismus surgery. In general, endophthalmitis after strabismus surgery has a poor visual prognosis. Early diagnosis and intervention with intravitreal antibiotics and possible vitrectomy may be advantageous for patients with a subretinal abscess.
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Affiliation(s)
- David K Coats
- Texas Children’s Hospital, 6701 Fannin Street, Clinical Care Center, Houston, TX 77030, USA
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Park K, Hong S, Chung W, Kim SS, Byeon SH, Seong GJ, Lee JB, Han SH. Inadvertent scleral perforation after strabismus surgery: incidence and association with refractive error. Can J Ophthalmol 2008; 43:669-72. [DOI: 10.3129/i08-151] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Spire M, Fleury J, Kodjikian L, Grange JD. [Retinal detachment caused by ocular perforation during periocular anesthesia: three case reports]. J Fr Ophtalmol 2007; 30:e16. [PMID: 17646743 DOI: 10.1016/s0181-5512(07)89671-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Local anesthesia for eye surgery was first described in 1884; later Knapp popularized retrobulbar anesthesia. To reduce risks, peribulbar anesthesia appeared in the 1970s. Still used today, periocular anesthesia is not without complications, in particular the risk of ocular perforation. PATIENTS AND METHODS Three patients were referred to our department for diagnosis and treatment of an intravitreous hemorrhage following cataract surgery. We report the clinical features, treatment, and visual outcome for these three patients. RESULTS The most common presentation was vitreous hemorrhage: the three eyes were found to have associated retinal detachment on initial assessment. One patient presented severe vitreoretinal proliferation with two postoperative recurrences; the globe was finally enucleated. The two other patients presented attached retina after surgery but had achieved very poor visual recovery. CONCLUSION Inadvertent globe perforation during local ocular anesthesia is rare. Careful attention to risk factors, early recognition, and prompt referral for management are recommended to improve the visual prognosis. Surgical management must be adapted to the severity of the perforation (vitreous hemorrhage, retinal detachment, vitreoretinal proliferation). The problems treating these patients with severe, often recurrent, retinal detachment, with poor visual prognosis, in a tricky forensic context should be emphasized.
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Affiliation(s)
- M Spire
- Service d'Ophtalmologie, Hôpital de La Croix Rousse, Lyon, France.
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Affiliation(s)
- Sean P Donahue
- Tennessee Lions Eye Center at Vanderbilt Children's Hospital and the Department of Ophthalmology, Vanderbilt University Medical Center, Nashville, USA
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Kuchenbecker J, Schmitz K, Behrens-Baumann W. Inadvertent scleral perforation in eye muscle versus retinal detachment buckle surgery. Strabismus 2006; 14:163-6. [PMID: 16950745 DOI: 10.1080/09273970600896844] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Inadvertent scleral perforation is a recognized complication of eye muscle and retinal detachment buckle surgery. If these operations are performed by the same surgeon, it is unknown which of these procedures has a higher risk of scleral perforation. METHODS In the period from 1999 until 2004, 427 eyes of 317 patients were operated using eye muscle surgery and 81 eyes of 80 patients with retinal detachment buckle surgery. All operations were performed by the same surgeon (JK). In a retrospective, single-center, comparative, observational study, the records of these patients were assessed to determine the number of scleral perforations with retinal damage or drainage of subretinal fluid. RESULTS In the group receiving retinal detachment buckle surgery there were two cases of scleral perforation. In one case, scleral perforation occurred during buckle installation and in the other case during placement of a cerclage. The rate of scleral perforation was 2.5 % per patient and per eye in this group. In the group receiving eye muscle surgery no scleral perforations occurred. CONCLUSION The number of scleral perforations was higher in retinal detachment buckle surgery than in eye muscle surgery, with all procedures having been performed by the same surgeon.
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Affiliation(s)
- Jörn Kuchenbecker
- Department of Ophthalmology, Otto von Guericke University, Magdeburg and Eye Hospital, HELIOS Hospitals, Berlin-Buch, Germany.
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Abstract
Inadvertent perforation of the sclera is a well-known complication of strabismus surgery. Scleral perforation may lead to retinal detachment, intraocular hemorrhage, cataract, hyphema, glaucoma, endophthalmitis, and phthisis bulbi. However, endophthalmitis following strabismus surgery is extremely rare, with an estimated incidence of 1:3500 to 1:185,000. We describe a case of Staphylococcus epidermidis endophthalmitis in an adult following strabismus surgery treated successfully with intravitreal antibiotics and corticosteroids.
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Affiliation(s)
- R Christopher Walton
- Department of Ophthalmology, University of Tennessee College of Medicine, Memphis 38163, USA.
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Abstract
OBJECTIVE To evaluate the incidence and identify associated risk factors of scleral penetrations and perforations resulting from strabismus surgery. METHODS A prospective observational study of patients undergoing strabismus surgery by residents or fellows was conducted. The surgical techniques employed included recessions, resections, advancements, posterior fixation sutures, and transpositions. Indirect ophthalmoscopy was performed on each operated eye following surgery to identify any retinal changes indicative of a penetration or perforation. RESULTS Of the 144 patients and 217 operated eyes, 11 sustained penetrations (5.1%), and 6 perforations (2.8%). On a per muscle procedure basis, the incidence of penetrations was 4.3% and of perforations 1.9%. The mean age at surgery for patients who experienced perforations was 4.8 years (+/- 5.3), which was less than those with penetrations or those without any complications (P = .016). The surgeon's experience was not related to the frequency of these complications. Penetrations or perforations were more likely to occur with rectus muscle recessions than resections (P = .0067). Horizontal rectus muscles were most frequently associated with penetrations and perforations when compared to vertical rectus and oblique muscles (P = .003). The S-24 needle was more frequently involved in the penetrations and perforations than other needles (P = .027). CONCLUSIONS In order to reduce the risk of scleral penetrations or perforations, surgeons should exercise caution when performing strabismus surgery in younger patients, when using S-24 needles, and when performing rectus muscle recessions. This study has demonstrated, for the first time with statistical significance, that recessions are more often associated with penetrations and perforations than other types of strabismus procedures.
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Affiliation(s)
- Yadvinder Dang
- Department of Ophthalmology and Pediatrics, King/Drew Medical Center, Los Angeles, CA, USA
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Wallace DK. Preoperative issues in adult strabismus. THE AMERICAN ORTHOPTIC JOURNAL 2001; 51:116-20. [PMID: 21149041 DOI: 10.3368/aoj.51.1.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Preoperatively, strabismus surgeons need to obtain informed consent, identify any ocular or systemic risk factors, decide on the preferred method of anesthesia, and determine whether the patient is an appropriate candidate for an adjustable suture technique. Three major categories of complications should be listed on the consent form: Loss of vision, double vison, and need for reoperation. If a patient is at particulary high risk to have one of these complications, then the surgeon should emphasize this point during the preoperative discussion. The incidence of visual loss after strabismus surgery due to anterior segment ischemia, retinal detachment, or endophthalmitis is approximately 1 in 7,400 cases. The preferred method of anesthesia depends on the procedure planned, the age and general health status of the patient, and whether or not an adjustable suture technique is to be utilized. At the conclusion of the preoperative discussion, the patient should be well informed and comfortable with the choice or procedure, have reasonable postoperative expectations in terms of diplopia, and be prepared for any unexpected complications.
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Abstract
Loss of a rectus muscle may occur as a rare complication of strabismus surgery. In addition, extraocular muscles may become traumatically detached from the globe when they rupture or are transected as the result of an injury or during the course of retinal detachment or paranasal sinus or orbital surgery. Although the clinical features of a slipped muscle may resemble those of a lost muscle, the findings at the time of reoperation are distinct. Also the etiology, and therefore the prevention, of a slipped muscle differs from that of a lost muscle. It is likely that slipped muscles and even some lost muscles are underdiagnosed and represent a significant cause of unexpected overcorrection or undercorrection. Unless the displaced muscle is appropriately advanced, it can be extremely difficult to correct the associated strabismus, yet locating and repairing either a lost or slipped muscle can be challenging and is by no means always successful. Current concepts pertaining to the etiology, recognition, and management of slipped and lost muscles will be discussed.
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Affiliation(s)
- A D Murray
- Department of Ophthalmology, University of Cape Town and Groote Schuur Hospital, Cape, Republic of South Africa
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Gray PJ. Ocular perforation during peribulbar anaesthesia. Eye (Lond) 1997; 11 ( Pt 3):425-6; author reply 428. [PMID: 9373496 DOI: 10.1038/eye.1997.95] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Affiliation(s)
- S E Olitsky
- Department of Ophthalmology, Children's Hospital of Buffalo, State University of New York, NY 14222, USA
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Abstract
PURPOSE Perforation of the retina is a major complication of strabismus surgery. The reported incidence of perforation varies from 0.13% to 12%. This study was undertaken to determine, from a large collaborative database, the incidence of suspected and unsuspected retinal and choroidal injury in pediatric horizontal muscle surgery. METHOD All children with horizontal strabismus surgery seen between September 1992 and October 1995 were examined with Indirect ophthalmoscopy immediately following their procedure. Surgery was performed by both resident and attending physicians. Cases involving muscle reoperation, high myopia, or patients with connective tissue disorders were excluded. RESULTS Strabismus surgery was performed on 765 patients, who underwent 1129 muscle recessions and 349 muscle resections. These children also had 161 vertical or oblique muscle procedures performed. Intraocular trauma resulting from horizontal muscle surgery was noted in 14 patient, including three retinal perforations. One of these patients was treated with cryotherapy; the other two received no therapy other than intraoperative and postoperative antibiotics. DISCUSSION The incidence of retinal perforation was 0.4% and the incidence of choroidal injury without perforation was 1.4% in this large series of children undergoing horizontal strabismus surgery. Retinal detachment or endophthalmitis did not develop during the 6-week follow-up period.
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Affiliation(s)
- L P Noel
- Children's Hospital of Eastern Ontario, Department of Ophthalmology, Canada
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Sprunger DT, Klapper SR, Bonnin JM, Minturn JT. Management of experimental globe perforation during strabismus surgery. J Pediatr Ophthalmol Strabismus 1996; 33:140-3. [PMID: 8771513 DOI: 10.3928/0191-3913-19960501-03] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The incidence of potentially vision-threatening globe perforation during strabismus surgery is reportedly between less than 1% and 12% of cases. Optimal treatment of globe perforation is not known; however, traditionally it has been treated with cryotherapy at the time of surgery or observation without treatment. The indirect-ophthalmoscope-directed diode laser may provide a safe and effective alternative treatment. METHODS We perforated the globes of six adult Dutch rabbits (12 eyes) and treated four eyes with cryotherapy and four with diode laser; the remaining four were not treated. RESULTS Histologic examination of the untreated eyes revealed a cellular reaction around the polyglactin suture that formed a non-uniform chorioretinal adhesion. The cryotherapy eyes had a tenuous chorioretinal adhesion and retinal pigment epithelium (RPE) cells in the vitreous on several sections. The laser-treated eyes had a firm, wide chorioretinal adhesion, with minimal tissue disruption and no release of RPE cells. No complications occurred. CONCLUSION We conclude that indirect-ophthalmoscope-directed diode laser retinopexy was safe and efficacious for globe perforation during strabismus surgery on rabbits and could be expected to be useful in humans.
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Affiliation(s)
- D T Sprunger
- Midwest Eye Institute, Indianapolis, IN 46280-1381, USA
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Kivlin JD, Wilson ME. Periocular infection after strabismus surgery. The Periocular Infection Study Group. J Pediatr Ophthalmol Strabismus 1995; 32:42-9. [PMID: 7752033 DOI: 10.3928/0191-3913-19950101-10] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Fewer than 15 cases of cellulitis and subconjunctival abscess after extraocular muscle surgery have been reported in detail. In an effort to provide greater information about this serious complication, the members of the American Association for Pediatric Ophthalmology and Strabismus (AAPO&S) were surveyed and contributed cases were analyzed. Among the 25 cases of cellulitis, there was a predominance of preschool age patients and Staphylococcus aureus cultures. Many cases presented after a normal initial postoperative visit. The most common symptoms were marked swelling and pain. Possible predisposing factors included unsuspected sinusitis, eye rubbing, and poor hygiene. Two patients had documented bacteremia, but no patient developed endophthalmitis. All cases resolved on antibiotics, but only five patients were successfully treated with oral antibiotics alone. Periocular infections after extraocular muscle surgery can present after a normal initial postoperative visit. Symptoms of marked swelling and pain are cause for closer inspection. S. aureus is the most common organism and oral antibiotics alone can fail to halt the infection.
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Affiliation(s)
- J D Kivlin
- Department of Ophthalmology, Pediatric Ophthalmology, Strabismus, and Genetics, Medical College of Wisconsin, Milwaukee, USA
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Simon JW, Hoot GP, Wassef H. Comparison of time required for strabismus correction by using the microscope or loupes. Am J Ophthalmol 1993; 115:672-3. [PMID: 8488924 DOI: 10.1016/s0002-9394(14)71471-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Affiliation(s)
- T Murray
- Department of Ophthalmology, University of Cape Town Medical School, Observatory, South Africa
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