Strabismus research review

The incidence and clinical outcome of complications in 4,000 consecutive strabismus operations

Ailsa E. Ritchie, Nadeem Ali

J AAPOS. 2019 May 4

Review: This is an interesting article that highlights the rate of complications in strabismus surgery, which can be used in the consent process.

In this prospective study, complications in more than 4000 cases of strabismus operations performed at Moorfields Eye Hospital NHS Foundation Trust between 2011 and 2016 were analysed. Complications were divided into three categories: minor complications - self-limiting and very unlikely to alter the outcome of surgery; moderate complications - requiring additional treatment but not likely to compromise the outcome of surgery; and severe complications – likely to result in a poor outcome, defined as loss of corrected visual acuity or unexpected primary position diplopia. The authors excluded over/under correction as well as Botulinum toxin injection.

The overall complication rate was 1.13% or 1 in 89. Severe complications were reported in 0.22% or 1 in 455.

Comment: The author concluded this study supports previously published incidence figures for severe complications in strabismus surgery and provides additional data on the incidence of less severe complications.

Based on these findings, when consenting patients for strabismus surgery, the incidence figures we now use are that there is a 1 in 100 risk of any complications, the majority of which are minor and resolve with nonsurgical treatment. There is a 1 in 400 risk of severe complications (including globe perforation, cellulitis, lost or slipped muscle) and a <1 in 2,000 risk of a poor visual outcome (meaning loss of visual acuity or unexpected double vision in the primary position).


Faden operation in consecutive esotropia

Min-Jung Kim, Kun-Hoo Na, Seung-Hyun Kim

Eye - May 2019

Review: This study reports on 25 children who developed consecutive esotropia following bilateral lateral recti recession and were treated between 2013-2018.

The patients were divided into two groups: the control group, which underwent medial recti (MR) recession only (15 children) and the Faden group who underwent MR recession with Faden procedure (10 children).

Surgical motor and sensory outcomes were compared between the Faden group and the control group. The results showed that the Faden group maintained orthotropia up to six months post operatively; the control group showed wider distribution of postoperative deviation angles (one patient with small angle esodeviation < 5 PD, three patients with esodeviation > 5 PD and three patients with exodeviation < 5 PD). In the Faden group, seven patients had good stereopsis (60″ or better) and three patients demonstrated fair stereopsis (80–3000″) after surgery. In the control group, four, eight and three patients showed good, fair and nil stereopsis respectively (P=0.026).

Comment: MR recession combined with Faden operation is a good surgical option for managing consecutive esotropia.


Analysis of peripapillary choroidal thickness in unilateral amblyopia

Gulfidan Bitirgen, Enver Mirza, Ahmet Ozkagnici and Mehmet Sinan Iyisoy

J Ophthalmic Vis Res. 2019 Jan-Mar; 14(1): 42–47

Review: Prospective study evaluating the peripapillary choroidal thickness (CT) using spectral-domain optical coherence tomography (SD-OCT) in 53 children with unilateral amblyopia, compared to 20 age-matched healthy controls with normal vision,

Of the 53 children, 29 (54.7%) had hyperopic anisometropic amblyopia and 24 (45.3%) had strabismic amblyopia. Peripapillary CT was measured from a 6mm length radial B-scan image at the optic nerve head using the enhanced depth imaging programme of an SD-OCT.

The results showed the average peripapillary CT was greater in amblyopic eyes than in fellow eyes and control eyes. In subgroup assessments, both the strabismic and anisometropic amblyopia subgroups had greater average peripapillary CT in amblyopic eyes compared to the fellow eyes.

When possible effects of AL on peripapillary CT were controlled using multivariate regression analysis, the average peripapillary CT was still greater in amblyopic eyes than in fellow eyes in the anisometropic amblyopia subgroup but not in the strabismic amblyopia subgroup.

The average peripapillary CT was 191.42 ± 47.41μm in amblyopic eyes and 162.37 ± 42.43μm in fellow eyes of patients with unilateral amblyopia (P = 0.002). Peripapillary CT in the temporal, nasal, superior, and inferior quadrants were also significantly higher in amblyopic eyes than in fellow eyes. After controlling for the possible effects of AL, the differences in all quadrants, except the nasal peripapillary CT remained significant. In the anisometropic subgroup, peripapillary CT in all quadrants were significantly higher in amblyopic eyes than in fellow eyes (P < 0.001 for all). When controlling for AL, the difference in superior peripapillary CT was no longer significant but the difference in peripapillary CT in other quadrants were statistically significant. In the strabismic subgroup, there was no significant difference in nasal peripapillary CT between amblyopic eyes and fellow eyes (P = 0.928) and the difference in superior and inferior peripapillary CT only slightly reached the threshold of significance (P = 0.048 and P = 0.049, respectively).

Comment: This study highlights that the choroid is thicker in the peripapillary area in children with anisometropic amblyopia. Further studies are required regarding this finding and whether it can be used as a diagnostic tool.

Rasha Altaie is a consultant ophthalmologist specialising in cornea and anterior segment disease and in paediatric ophthalmology. She is a senior lecturer at the University of Auckland and works as a specialist with Counties Manukau District Health Board and Milford Eye clinic.


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