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Simultaneous Versus Sequential Ptosis and Strabismus Surgery in Children
Karen E Revere1, Gil Binenbaum, Jonathan Li
1Department of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A.
Insights
Simultaneous ptosis and strabismus surgery in children is as effective and safe as sequential procedures. Combining surgeries reduces anesthesia exposure without increasing complications or reoperations.
Area of Science:
- Ophthalmology
- Pediatric Surgery
Background:
- Children with ptosis and strabismus often require multiple surgical interventions.
- Sequential surgeries necessitate separate anesthetic events, increasing exposure and potential risks.
Purpose of the Study:
- To compare clinical outcomes of simultaneous versus sequential ptosis and strabismus surgery in pediatric patients.
- To evaluate the safety and efficacy of combining these procedures.
Main Methods:
- Retrospective cohort study of 56 children undergoing ptosis and strabismus surgery on the same eye.
- Simultaneous surgery: single anesthetic event. Sequential surgery: at least 7 weeks apart.
- Outcomes assessed: surgical success rates, complications, and reoperations.
Main Results:
- No significant differences in success rates, complications, or reoperations between simultaneous and sequential surgery groups (p > 0.28).
- Congenital ptosis and comitant strabismus were common indications.
- Common ptosis procedures included frontalis sling and Fasanella-Servat.
Conclusions:
- Simultaneous ptosis and strabismus surgery is clinically effective and safe in children.
- Combining procedures does not increase postoperative complications or reoperation rates.
- Simultaneous surgery reduces overall anesthesia exposure for pediatric patients.
Purpose:
The authors sought to compare the clinical outcomes of simultaneous versus sequential ptosis and strabismus surgery in children.
Methods:
Retrospective, single-center cohort study of children requiring both ptosis and strabismus surgery on the same eye. Simultaneous surgeries were performed during a single anesthetic event; sequential surgeries were performed at least 7 weeks apart. Outcomes were ptosis surgery success (margin reflex distance 1 ≥ 2 mm, good eyelid contour, and good eyelid crease); strabismus surgery success (ocular alignment within 10 prism diopters of orthophoria and/or improved head position); surgical complications; and reoperations.
Results:
Fifty-six children were studied, 38 had simultaneous surgery and 18 sequential. Strabismus surgery was performed first in 38/38 simultaneous and 6/18 sequential cases. Mean age at first surgery was 64 months, with mean follow up 27 months. A total of 75% of children had congenital ptosis; 64% had comitant strabismus. A majority of ptosis surgeries were frontalis sling (59%) or Fasanella-Servat (30%) procedures. There were no significant differences between simultaneous and sequential groups with regards to surgical success rates, complications, or reoperations (all p > 0.28).
Conclusions:
In the first comparative study of simultaneous versus sequential ptosis and strabismus surgery, no advantage for sequential surgery was seen. Despite a theoretical risk of postoperative eyelid malposition or complications when surgeries were performed in a combined manner, the rate of such outcomes was not increased with simultaneous surgeries. Performing ptosis and strabismus surgery together appears to be clinically effective and safe, and reduces anesthesia exposure during childhood.
