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Changes in Lateral Comitance After Asymmetric Horizontal Strabismus Surgery.

Carolyn P Graeber¹, David G Hunter¹

¹Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts2Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.

JAMA Ophthalmology

|August 21, 2015

Summary

This summary is machine-generated.

Asymmetric strabismus surgery can improve side gaze alignment but may cause new, symptomatic deviations in previously aligned patients. Careful surgical planning is crucial to avoid functional and social deficits.

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Area of Science:

Ophthalmology
Surgical Innovation
Strabismus Management

Background:

Horizontal strabismus surgery often prioritizes primary gaze alignment.
Surgical choices can impact side gaze alignment, potentially causing functional and social issues.

Purpose of the Study:

To identify surgical procedures linked to changes in side gaze alignment.
To inform surgical planning for horizontal strabismus patients.

Main Methods:

Retrospective review of 1081 horizontal strabismus surgeries.
Inclusion of records with pre- and post-operative strabismus measurements in right and left gaze.
Analysis of change in comitance (CIC) using horizontal comitance measurements.

Main Results:

Asymmetric surgery was associated with new postoperative incomitance in 89.9% of previously comitant patients.
Asymmetric 2-muscle surgery resulted in a significantly higher median CIC (4.0) compared to symmetric surgery (1.5).
Symptomatic new incomitance occurred in 28.8% of patients following asymmetric surgery.

Conclusions:

Asymmetric strabismus surgery can correct existing incomitant deviations but may induce new symptomatic ones.
Surgical planning must consider the potential for change in comitance (CIC) and its impact on side gaze.
Careful consideration of asymmetric surgery consequences is vital for patients with binocular vision to prevent diplopia.