Re-Operation Strategies in Strabismus—Cooper’s Dictum Amended

ABSTRACT

Purpose: To outline a systematic approach to strabismus reoperations. Many strabismologists have a formulaic approach to strabismus reoperations, e.g., treat it as a fresh case, advance previously recessed muscles to the original insertion, etc.

Patients and methods: This paper is a collection of pearls gained from the author’s 40+ years in practice.

Results: Effective strategies for strabismus reoperations are not formulaic and should be tailored to the specific history and findings of the patient. The first, and most important decision, is whether to operate on previously operated muscles or fresh muscles. This should be influenced, in part, by whether one is treating an overcorrection or undercorrection. Limitations of rotations and incomitance patterns should be addressed. Many important decisions should be made intraoperatively based on where muscles are found, their integrity (slipped in the capsule, stretched scar, etc.), repeated intraoperative forced ductions, and spring back balance testing.

Conclusion: A proper plan for a strabismus reoperation takes into account a number of preoperative factors, and the surgeon should be prepared to modify the plan based on intraoperative findings.

KEYWORDS:

• Strabismus
• surgery
• restrictive strabismus
• stretched scar
• lost muscle
• psychosocial deprivation

Acknowledgments

This work was supported by an unrestricted grant from Research to Prevent Blindness, Incorporated, New York, NY, USA.

Presented in part at the joint regional orthoptic meeting of the AACO, May 5, 2017, Detroit, MI, USA.

Presented in part as the First Arthur Jampolsky Lecture at the joint meeting of AAPOS and the ISA, March 19, 2018, Washington, DC, USA.

Modified from the author’s previously published textbook chapter on this subject.⁶

Additional information

Funding

This work was supported by an unrestricted grant from Research to Prevent Blindness, Incorporated, New York, NY, USA.