Clinical Audit of Horizontal Strabismus Surgery in Children in Maharashtra, India

Abstract

Background: The study aimed to audit the results of horizontal strabismus surgery in the hospital’s pediatric ophthalmology department in Maharashtra, India.

Method: Medical records of strabismus surgeries done over 3 years were collated. Preoperative visual acuity, deviation, refraction, and orthoptic evaluation were noted as well as post-operative residual deviation and patient satisfaction. Post-operative residual deviation ≤ 10Δ was considered good outcome, 11–20Δ borderline, and > 20Δ was considered poor outcome. The surgeons were briefed about their results periodically and the cause of poor outcomes discussed.

Result: Between March 2004 and December 2007, 529 children were operated upon, of whom 461 (87.1%) completed the 6-week follow-up. Average age was 9 years 7 months (range 1–19 years). 260/461 (56.3%) patients had good, 100/461 (21.6%) borderline, and 101/461 (21.9%) had poor outcome. 133/231 (57.6%) cases of esotropia and 127/230 (55.2%) cases of exotropia had a good outcome, while the poor outcome was 50/231 (21.6%) and 51/230 (22.1%), respectively. Bilateral medial rectus recession for esotropia had 25/56 (44.6%) good outcome and 15/56 (26.7%) poor outcome, while recess-resect procedures (R/R) for esotropia had 108/175 (61.7%) good and 35/175 (20%) poor outcome (p = 0.062). Bilateral lateral rectus recession for exotropia had 30/56 (53.6%) good and 12/56 (21.4%) had poor outcome, while for recess-resect procedures for exotropia it was 97/174 (55.7%) good and 39/174 (22.4%) poor outcome (p = 0.97). The result did not significantly change over 3 years. 433/461 (93.9%) expressed satisfaction about the surgery on 6-week follow-up. Large pre-operative deviations and amblyopic eyes accounted for 63/101 (62.3%) cases of poor outcome. Fifty-seven patients recorded an improvement in stereopsis.

Conclusion: Recess-resect procedures had better outcome as compared to bilateral recess procedures, but it was not statistically significant. Clinical audit helped maintain and improve good outcome over the 3 years.

KEYWORDS::

• clinical audit
• strabismus surgery
• exotropia
• esotropia
• patient satisfaction
• stereopsis

ACKNOWLEDGMENTS

ORBIS India country office supported the pediatric ophthalmology department of H. V. Desai Eye Hospital. We thank Dr. Radhika Bokil and Dr. Shruti Wardhamane helped collate the data. Statistical backup was provided by Mrs. Swapna Deshpande.

This research was funded by H. V. Desai Eye Hospital, Pune, India. The authors have no financial interests to declare.

Declaration of Interest: The authors have no conflicts of interest to declare. The authors alone are responsible for the content in the article.