Which Angle for which Surgical Strategy in Comitant Strabismus?

Area of Science:

• Ophthalmology
• Surgical Techniques
• Pediatric Eye Care

Background:

• Conventional strabismus surgery uses the fusion-free angle as a reference, but this may not align with the basic angle in all comitant strabismus types.
• Infantile esotropia presents a minimum angle and an angle of variability, requiring combined surgical techniques for optimal correction.
• Prism adaptation tests aid in determining the basic angle for normosensorial strabismus, while intraoperative assessment of muscle forces is crucial.

Purpose of the Study:

• To evaluate the efficacy of intraoperative adjustments in strabismus surgery.
• To determine if considering passive muscle force imbalance and varied deviation angles improves surgical outcomes.
• To reduce the variability of results in infantile esotropia correction.

Main Methods:

• A series of 80 children with infantile esotropia underwent surgery involving bilateral posterior fixation sutures and medial rectus recessions.
• Intraoperative data, including eye position and muscle extensibility, were recorded to assess passive muscle forces.
• The amount of medial rectus recession was initially calculated based on the minimum angle and adjusted intraoperatively using the recorded data.

Main Results:

• Long-term follow-up (≥2 years) indicated that surgical failures were more frequent in cases without intraoperative adjustments.
• Intraoperative data on passive muscle forces provided valuable parameters for refining surgical intervention.
• Adjusting surgery based on intraoperative findings suggests a potential reduction in outcome variance.

Conclusions:

• Intraoperative adjustment of surgical amount is indicated based on the imbalance of passive muscle forces.
• This strategy, incorporating varied deviation angles, shows promise in reducing outcome variance in strabismus surgery.
• Further long-term results are expected to confirm the benefits of this adjusted surgical approach.