strabismus surgery made simple: dr. madhu karna strabismologist
TRANSCRIPT
Strabismus Resurgery Strabismus Resurgery made made SimpleSimple
Dr. Madhu KarnaDr. Madhu KarnaStrabismologistStrabismologist
6 months Postop turns into 6 months Postop turns into Consecutive exotropiaConsecutive exotropia
realigned after Resurgeryrealigned after Resurgery
TipTip
Risk factors for overcorrection- A pattern, Risk factors for overcorrection- A pattern, amblyopia, high hyperopia.amblyopia, high hyperopia.
Risk factors for undercorrection –amblyopia. Risk factors for undercorrection –amblyopia.
**Strabismus surgery only after amblyopia Strabismus surgery only after amblyopia has been fully treatedhas been fully treated..
Right eye third nerve palsy after Right eye third nerve palsy after two squint surgeriestwo squint surgeries
Using props on the glasses to lift Using props on the glasses to lift the lid after alignment from the lid after alignment from
previous surgeriesprevious surgeries
Residual exotropia or progession of Residual exotropia or progession of palsy - Reinvestigatepalsy - Reinvestigate
TrickTrick
First surgery resultFirst surgery result
Progressive problemProgressive problem
Unmasking of other components - Unmasking of other components - Reoperations inevitableReoperations inevitable
When to reoperateWhen to reoperate
At least 2 months after the initial surgery At least 2 months after the initial surgery except:except:
Lost or slipped muscleLost or slipped muscle Large overcorrection after an SO tuckLarge overcorrection after an SO tuck Large vertical deviations induced by Large vertical deviations induced by
muscle transposition proceduresmuscle transposition procedures
This squint may trap you by This squint may trap you by seeming simple butseeming simple but
HYPEROPIA WITH EXOTROPIAHYPEROPIA WITH EXOTROPIA
Before you operate Before you operate this patientthis patient
Just remove the Just remove the glassesglasses
High hyperopia with Accomodative High hyperopia with Accomodative Esotropia with Consecutive ExotropiaEsotropia with Consecutive Exotropia
Reduce hyperopic power by halfReduce hyperopic power by half If exotropia still manifest or there is a drop If exotropia still manifest or there is a drop
in visual acuity then operate on the in visual acuity then operate on the consecutive Exotropia after measuring consecutive Exotropia after measuring over maximum cyclopegic refraction.over maximum cyclopegic refraction.
Conservative Vs AggressiveConservative Vs Aggressive
Sensory strabismus mainly sensory Sensory strabismus mainly sensory exotropia exotropia
Do FDT Do FDT Release the restrictions and do maximum Release the restrictions and do maximum
recess- resect recess- resect Inferior Oblique and SO can be weakened Inferior Oblique and SO can be weakened
which are additional abductorswhich are additional abductors.. Raab, unilateral 4 muscle study for large angle Raab, unilateral 4 muscle study for large angle
exotropia, Ophthal, 1979: 86, 1441exotropia, Ophthal, 1979: 86, 1441
END- Effort Never DiesEND- Effort Never Dies
Reop expected in 5-10% of patients who Reop expected in 5-10% of patients who undergo squint surgeryundergo squint surgery
Any reop introduces a 33% probability of yet Any reop introduces a 33% probability of yet another procedureanother procedure
We will make 100% effort to make this the last We will make 100% effort to make this the last squint surgery neededsquint surgery needed
We really don’t learn anything from our We really don’t learn anything from our experience we only learn from reflecting experience we only learn from reflecting on our experience.on our experience.
Strabismus surgery only after amblyopia Strabismus surgery only after amblyopia has been fully treatedhas been fully treated
Progressive problem Progressive problem Operate on the consecutive Exotropia Operate on the consecutive Exotropia
after measuring over maximum cyclopegic after measuring over maximum cyclopegic refractionrefraction
In Sensory Exotropias Inferior Oblique In Sensory Exotropias Inferior Oblique and SO can be weakened which are and SO can be weakened which are additional abductors additional abductors