Scleral perforation during posterior scleral fixation: incidence and management strategies

To identify the incidence and clinical outcomes of scleral perforation during posterior fixation suture surgery in strabismus patients.

This was a retrospective chart review of patients who underwent posterior fixation suture surgery at the Strabismus Unit of Beyoglu Eye Training and Research Hospital between January 2017 and March 2021. Patients with complete ophthalmological records were included. Data collected included surgical indication, visual acuity, and retinal findings. Patients with suspected scleral perforation were evaluated and monitored in collaboration with the vitreoretinal unit.

A total of 152 eyes from 121 patients (67 females, 54 males; mean age: 12.3 ± 16.2 years, range 2-55) were included. Scleral perforation occurred in 6 patients (3%), all during medial rectus muscle surgery. Three of these cases were treated with argon laser photocoagulation, and three were observed without intervention. No cases developed retinal detachment, endophthalmitis, or vitreous hemorrhage. Final best-corrected visual acuity remained stable in all affected patients.

Scleral perforation is an uncommon complication of the posterior fixation suture procedure, with all observed cases limited to medial rectus surgery. Although visual prognosis was favorable, careful intraoperative technique and postoperative monitoring are essential to detect and manage potential complications.