Sadia Bukhari, Abdul Sami Memon, Umair Qidwai.
Surgical Management of Strabismus, our Experience.
Ophthalmol Update Jan ;12(3):186-91.

Objective: To evaluate the effectiveness of multiple surgical techniques in different types of strabismus Study design: Observational case series. Place & Duration of Study: Al Ibrahim Eye Hospital, Karachi, from July 2007 to December 2012. Methodology: It was an observational Case-series, Patients having either primary exotropia (deviation 15-45 PD), constant esotropia or hypertropias were included in the study. Patients with either constant exotropia or basic intermittent exotropia underwent unilateral surgery of lateral rectus recession (maximum up to 10mm) and medial rectus resection (up to 6mm). Similarly, when patients had intermittent distance exotropia, underwent bilateral lateral rectus recession ((maximum up to 10mm). Patients with constant esotropia underwent either bi-medial rectus recession or unilateral medial rectus recession or unilateral medial rectus recession along with lateral rectus resection procedures. Patients with hypertropia underwent inferior oblique myectomy. Patients were re-evaluated at one week, one month and two months post operatively. Final outcome was considered at the end of two months at which achievement of ?10 PD of exotropia/esotropia was considered as a success. Analysis was done using SPSS version 20.0. Results: 578 patients were included in the study according to inclusion and exclusion criteria. Out of these 578 patients, 283 (48.96%) were male while rest of 295 (51.04%) were female. Out of these, 248 patients had exotropia. Mean angle of deviation observed before surgical correction was 49.23 prism diopters (standard deviation=10.43). After surgical correction, mean angle of deviation was 8.54 prism diopters (standard deviation=9.55). Overall success rate was 81.45% (202 patients) in cases of exotropia. Overall 272 patients with esotropia were included. Mean angle of deviation was 53.71 prism diopters (±17.18). Minimum angle of deviation was 20 prism diopters while the maximum angle was 90 prism diopters. Mean deviation after surgery was 9.73 prism diopters (±12.03).Surgical success as described as residual deviation of less than 10 prism diopters was seen in 202 (74.3%) of the patients. During the study period, 58 patients with hypertropia were included. The mean age of the patients included in study was 11.71 years (±7.95). Mean angle of hypertropia before surgery was 13.55 prism diopters (± 4.43). This reduced to 0.48 prism diopters after surgery. Out of 58 patients, 55 (94.8%) had achieved success after surgery while only 3 (5.2%) patients had residual hypertropia of greater than 2 prism diopters (p=0.001). Conclusion: In this study we have compared the different methods of surgical corrections of exotropia/esotropia and vertical deviations. It has been observed that one method that is unilateral lateral rectus recession and medial rectus resection has better surgical success rate as compared to the other method which is bilateral lateral rectus recession in exotropia correction. On the other hand no significant difference was observed in the success rate of different surgeries in esotropia. Isolated inferior oblique myectomy is highly successful and safe surgical procedure for correction of hypertropia.

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