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Long-term outcomes of adjustable strabismus surgery at a Pakistani university hospital

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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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Funding

The author certifies that she has no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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Authors and Affiliations

  1. Department of Ophthalmology, Foundation University Islamabad/Fauji Foundation Hospital, Defence Avenue, Phase-I, DHA, 44000, Islamabad, Pakistan

    Sana Nadeem

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  1. Sana Nadeem
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Correspondence to Sana Nadeem.

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Conflict of interest

The author has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the ‘Foundation University Ethical Review Committee’ [217–1/FF/FUMC/ERC] and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Clinical trial registration

This trial is registered at ClinicalTrials.gov with the identifier: NCT05425589.

Data sharing statement

The data for this study are available from Open Science Framework with the https://doi.org/10.17605/OSF.IO/36SDE and link: https://osf.io/36sde/?view_only=d7f88ff63b094350a7c4563b18c70f3e.

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Nadeem, S. Long-term outcomes of adjustable strabismus surgery at a Pakistani university hospital. Int Ophthalmol 43, 825–836 (2023). https://doi.org/10.1007/s10792-022-02484-2

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