Early strabismus surgery in patients with strabismus and amblyopia: a therapeutic outcomes study

Early strabismus surgery may improve visual outcomes in patients with coexisting strabismus and amblyopia; however, the optimal timing of surgical intervention remains uncertain. This study evaluated the efficacy of early surgical correction and explored the appropriate timing of surgery in this population.

This retrospective case series included 40 patients (age range, 3-23 years) diagnosed with concomitant strabismus and amblyopia at the Ophthalmology Department of the First Affiliated Hospital of Guangxi Medical University between January 2019 and October 2022. All patients showed a suboptimal response to 3-6 months of standardized amblyopia treatment, defined as visual acuity improvement of less than two lines on a standard visual acuity chart, with a stable angle of deviation, defined as variation ≤ 5 prism diopters. Patients underwent strabismus surgery followed by continued amblyopia therapy. The median follow-up duration was 6.0 months (interquartile range [IQR], 3.0-9.75 months). Clinical parameters included surgical age, sex, strabismus type (esotropia or exotropia), amblyopia severity, best-corrected visual acuity (BCVA), ocular alignment in prism diopters, and binocular vision function, including simultaneous perception and stereopsis. Preoperative and postoperative outcomes were compared using a self-controlled design; subgroup analyses were performed for esotropia and exotropia.

Postoperative BCVA in amblyopic eyes improved significantly from 0.35 logMAR (IQR, 0.25-0.68) to 0.18 logMAR (IQR, 0.1-0.3; P < 0.001), with a mean improvement of 0.23 ± 0.19 logMAR. Orthophoria was achieved in 87.5% of cases; five patients showed recurrent deviation, including one requiring reoperation. Recovery of binocular function, viz. simultaneous vision was achieved in 60.0% of patients; stereopsis was achieved in 23.3% of patients. Younger age at surgery was significantly associated with greater improvement in BCVA (P = 0.001). Final BCVA, alignment success, and binocular outcomes remained comparable between esotropia and exotropia eyes (all P > 0.05).

In patients with coexisting strabismus and amblyopia exhibiting suboptimal response to conservative therapy but with stable deviations, early surgical correction combined with postoperative amblyopia management demonstrates potential early emergence of significant visual gains, robust binocular recovery, and maintenance of ocular stability. However, interpretations should consider the study's retrospective, short-term, and uncontrolled design.