Reoperation of strabismus, points to be considered

Abstract

Purpose The aim was to obtain the best results when dealing with previously operated cases of strabismus, as regards the restoration of ocular alignment, regaining ocular motility at least in the central field and at the same time aiming at preserving equal vertical width of the palpebral fissure in both the eyes. Participants and methods Effective strategies for strabismus reoperations are controversial, and should be tailored to each patient, depending on the specific history and findings. The first decision is to operate on previously operated muscles or fresh muscles. This should be influenced by many factors, in part by whether we are treating an undercorrection or an overcorrection, limitations of rotations, and incomitance, and by the vertical width of the palpebral fissure in the two eyes. Also many important decisions should be made intraoperatively based on the muscles integrity, whether slipped, lost, tight, hypertrophied, and also according to forced duction test. Results The total number of cases included in this study were 175 patients. Most of them were exotropic, 102 (58.3) cases, 67 women and 35 men, most of them (80 cases, 78.5%) were residual or recurrent. Esotropia constituted 59 (33.7%) cases, most of them were residual (46 cases). New types of deviation presented in 8% of cases. Management decision depended on the presenting deviation, its angle, ocular motility and any limitation, forced duction test, vertical width of the palpebral fissure, and modified according to the anatomical findings during the surgery. Conclusion A proper plan for a strabismus reoperation takes into consideration a number of factors preoperatively, and the surgeon should be prepared to modify his plans in each patient according to the intraoperative findings.

Keywords

• consecutive strabismus
• residual strabismus
• restrictive strabismus
• vertical palpebral fissure height