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Major Complications following Strabismus Surgery: Nine-year Data from the IRIS® Registry
R Michael Siatkowski1, Christie L Morse2, Robert S Gold3
1Dean McGee Eye Institute, University of Oklahoma Department of Ophthalmology, Oklahoma City, Oklahoma.
Ophthalmology
|November 30, 2025
Summary
Major complications after strabismus surgery are rare, affecting 0.115% of patients. Increasing age and combined vertical/horizontal muscle surgery are key risk factors, necessitating early postoperative assessment.
Area of Science:
- Ophthalmology
- Surgical Outcomes
- Public Health
Background:
- Strabismus surgery is common, but data on major postoperative complications are limited.
- Understanding complication rates and risk factors is crucial for patient safety and informed consent.
Purpose of the Study:
- To determine the occurrence rates of major complications following strabismus surgery.
- To identify associated risk factors for these complications in a large patient cohort.
Main Methods:
- Retrospective analysis of 89,339 patients undergoing strabismus surgery from the IRIS® Registry (2013-2021).
- Analysis of diagnostic and procedural codes for bacterial keratitis, orbital infection, endophthalmitis, and lost/slipped muscle.
- Evaluation of complication frequency, risk factors, presentation timing, and visual outcomes.
Main Results:
- Overall complication rate was 0.115%, with lost/slipped muscle (0.04%) and corneal ulcers/orbital infection (0.03% each) being most frequent.
- Increasing age was a risk factor for most complications; female sex and age >65 were linked to endophthalmitis.
- Combined vertical and horizontal muscle surgery and increased procedural codes were independent risk factors; visual loss occurred in most patients with complications.
Conclusions:
- Findings provide data for improved informed consent regarding strabismus surgery risks.
- Recommend postoperative assessment within 5 days to enable early detection of major complications.
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