The Pan-American Journal of Ophthalmology (Jan 2023)
Long-term surgical outcomes of unilateral horizontal muscle strabismus surgery in patients with sensory esotropia versus sensory exotropia
Abstract
Purpose: To compare the long-term postoperative outcomes of unilateral horizontal muscle strabismus surgery in patients with sensory esotropia and sensory exotropia. Methods: This retrospective study included 30 patients of sensory deviation who underwent strabismus surgery between January 2017 and December 2020 and had 24 months of follow-up. The patients were classified into Group A (sensory esotropia) and Group B (sensory exotropia) of 15 each. The successful outcome was assigned to a patient with postoperative deviation ≤10 prism dioptres (PD) in primary position. Results: The mean age of the sample was 20.87 ± 6.88 years, 18 were male (60%) and 12 were female (40%). The mean preoperative deviation in Group A was 38.8 ± 10.46 PD and in Group B, it was 48.0 ± 5.92 PD. Successful surgical outcome (≤10 PD) at postoperative day 1 was achieved in 29 patients (96.77%). One patient (3.33%) having sensory exotropia was found to have residual deviation >10 PD. These results were maintained at the 6th month and 12th month of follow-up and there was no significant difference between surgical outcomes of both groups (Chi-square test, P = 0.309). At the 24th month follow-up, 23 patients maintained good surgical outcome; all seven patients who had surgically failed outcome (>10 PD) belonged to the exotropia group, which was statistically significant (Chi-square test, P = 0.002). The mean postoperative deviation at the final visit at 24 months of follow-up in Group A was 3.6 ± 2.16 PD and in Group B, it was 10.87 ± 2.82 PD. The long-term outcomes are significantly worse in patients of sensory deviations with organic vision loss and sensory exotropia. Other factors which determined the long-term successful postoperative outcome were best-corrected visual acuity (BCVA), childhood-onset strabismus, and younger age at surgery. Conclusions: Good primary position alignment can be achieved in patients with sensory deviations with single strabismus surgery. Type of deviation, BCVA, age of onset, and age at the time of surgery were the factors associated with successful long-term alignment.
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