After a conclusive diagnosis has been made, meticulous surgical planning and its execution form the final steps in successful management of strabismus. This chapter will highlight the points to be considered while planning strabismus surgery.
While achieving a near perfect alignment of visual axes is the aim, ocular alignment in at least the primary and downgaze is most desirous (Table 7.1). This may be achieved by either “correcting the defect” or by “matching the defect” of the sound eye to the squinting eye. At the same time, all considerations must also be made to ensure sensory recovery as achieving good binocular functions is the ultimate goal of any strabismus surgery. Binocular function recovery depends on multiple factors like vision, age of onset, duration and stability of deviation along with preoperative binocular functions (Table 7.2). An adult with early-onset, long-standing, constant (no intermittency or variability) deviation with poor vision in deviating eye and poor binocular functions can be expected to have an unfavourable prognosis in terms of sensory recovery (Singh et al., J Pediatr Ophthalmol Strabismus 45:104–108, 2008).
The surgeon should also spend time to understand the expectations of the patient and see if they match with the expected surgical outcome. This would avoid disappointment and hours of postoperative counselling.
Arc of contact Prism adaptation test Forced duction test Force generation test Surgical dosage
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