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Retinal perforation in strabismus surgery
L P Noel1, J N Bloom, W N Clarke
1Children's Hospital of Eastern Ontario, Department of Ophthalmology, Canada.
Insights
Retinal perforation occurred in 0.4% of pediatric strabismus surgeries, with choroidal injury in 1.4%. No retinal detachments or infections were observed in this study of horizontal muscle surgery complications.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Ocular Trauma
Background:
- Retinal perforation is a significant complication associated with strabismus surgery.
- Previous studies report a wide incidence range for retinal perforation, from 0.13% to 12%.
Purpose of the Study:
- To determine the incidence of suspected and unsuspected retinal and choroidal injury during pediatric horizontal muscle surgery.
- To analyze data from a large collaborative database to assess complication rates.
Main Methods:
- A retrospective analysis of 765 children undergoing horizontal strabismus surgery between September 1992 and October 1995.
- Indirect ophthalmoscopy was performed immediately post-surgery for all patients.
- Exclusion criteria included muscle reoperation, high myopia, and connective tissue disorders.
Main Results:
- A total of 1129 muscle recessions, 349 muscle resections, and 161 vertical/oblique muscle procedures were performed.
- Intraocular trauma was observed in 14 patients (1.8%), including three cases of retinal perforation (0.4%).
- Choroidal injury without perforation was noted in 1.4% of cases.
Conclusions:
- The incidence of retinal perforation in pediatric horizontal strabismus surgery is 0.4%.
- The incidence of choroidal injury without perforation is 1.4%.
- No cases of retinal detachment or endophthalmitis were reported within the 6-week follow-up period.
Purpose:
Perforation of the retina is a major complication of strabismus surgery. The reported incidence of perforation varies from 0.13% to 12%. This study was undertaken to determine, from a large collaborative database, the incidence of suspected and unsuspected retinal and choroidal injury in pediatric horizontal muscle surgery.
Method:
All children with horizontal strabismus surgery seen between September 1992 and October 1995 were examined with Indirect ophthalmoscopy immediately following their procedure. Surgery was performed by both resident and attending physicians. Cases involving muscle reoperation, high myopia, or patients with connective tissue disorders were excluded.
Results:
Strabismus surgery was performed on 765 patients, who underwent 1129 muscle recessions and 349 muscle resections. These children also had 161 vertical or oblique muscle procedures performed. Intraocular trauma resulting from horizontal muscle surgery was noted in 14 patient, including three retinal perforations. One of these patients was treated with cryotherapy; the other two received no therapy other than intraoperative and postoperative antibiotics.
Discussion:
The incidence of retinal perforation was 0.4% and the incidence of choroidal injury without perforation was 1.4% in this large series of children undergoing horizontal strabismus surgery. Retinal detachment or endophthalmitis did not develop during the 6-week follow-up period.
