Stepped Strabismus Surgery

Abstract

Purpose

To present stepped strabismus surgery as a novel technique in cases of small to moderate angle strabismus.

Methods

Retrospective chart review of cases of stepped strabismus surgery from 2010 untill 2018. In stepped surgery, the first muscle is operated on under rapid induction-recovery IV propofol infusion. Patient is assessed in the OR. If deemed necessary, other muscles are operated on under general anesthesia. No adjustable sutures are used.

Results

The technique was used in 22 cases of superior oblique palsy (SOP) (primary position hypertropia in the range of 12–25 prism diopters) and 29 horizontal strabismus cases (angles in the range 12–20 prism diopters). The first step was an inferior oblique myectomy in the SOP cases and a single rectus recession in the horizontal cases. After intraoperative assessment, 31% (16/51) needed additional muscle surgery. After 6 months of follow up, the overall reoperation rate was 9%. The technique was well tolerated by all patients.

Conclusion

Stepped strabismus surgery is a useful technique for small to moderate angle strabismus cases with the potential for reducing the number of extraocular muscles operated on without compromising the surgical outcome.

Keywords:

• anesthesia
• anesthetics
• intravenous
• oculomotor muscles/surgery
• propofol
• retrospective studies
• strabismus/surgery

Acknowledgments

This work was presented in part at the 45th Annual Meeting of the American Association for Pediatric Ophthalmology and Strabismus, San Diego, CA, March 27–31, 2019. This paper was presented at the Annual Meeting of the American Association for Pediatric Ophthalmology and Strabismus as a poster presentation with interim findings. The poster’s abstract was published in “Poster Abstracts” in the Journal of American Association of Pediatric Ophthalmology and Strabismus: https://doi.org/10.1016/j.jaapos.2019.08.019. Institution at which the study was conducted: Department of Ophthalmology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.

Disclosure

The authors declare that there is no conflict of interest.

Additional information

Funding

The authors report no funding for this study.