Minimally Invasive Strabismus Surgery: A Systematic Review and Meta-Analysis of Clinical Complications and Efficacy

Minimally invasive strabismus surgery (MISS) has emerged as a promising alternative to traditional strabismus surgery. This meta-analysis aimed to compare the efficacy and safety of MISS with the standard surgical approach. A comprehensive literature search was conducted to identify relevant studies that included patients who complained of strabismus and underwent MISS or traditional surgeries, English studies, and that were conducted from conception until November 16, 2024. Pooled analysis was performed to compare postoperative alignment, visual acuity, surgery duration, and various postoperative complications between MISS and the standard approach. MISS demonstrated comparable outcomes to the standard approach in terms of postoperative alignment and visual acuity. It was associated with significantly shorter operative times. Both techniques had similar postoperative complication profiles, with MISS showing a lower risk of postoperative scarring. However, the risk of bias in some studies and the limited number of studies for certain outcomes raise concerns about the generalizability of the findings. This meta-analysis suggests that MISS is a safe and effective alternative to traditional strabismus surgery. It offers the advantages of shorter operative time and reduced postoperative scarring. Further high-quality randomized controlled trials are needed to confirm these findings and to assess the long-term outcomes of MISS.