Late Surgical Correction of Longstanding Constant Strabismus in Adults: Is Fusion Possible in All Successfully Aligned Patients?

ABSTRACT

Purpose

To determine whether late surgical correction provides fusion in adults who have constant strabismus beginning in early childhood.

Materials and Methods

This was a prospective study that included 34 consecutive adults with a history of early onset strabismus who had not previously undergone surgery. They were tested with the Bagolini striated glasses (BSG), Worth four-dot (W4D) test, cover test, and four-prism diopter (4-PD) test, preoperatively, and 6 weeks after surgery.

Results

The mean age was 23.8 years, 17 patients had esotropia and 17 patients had exotropia. Preoperatively, all patients demonstrated a manifest horizontal deviation ranging from 30^∆ to 60^∆ and had suppression. At 6 weeks postoperatively, 33 patients had a horizontal manifest deviation of <15^∆ (range, 2^∆-14^∆; median, 6^∆), and none were orthotropic as determined by the cover test together with the 4-PD test. All of these 33 patients achieved anomalous retinal correspondence (ARC) with the BSG at near, and 25 (75%) had ARC with the W4D test at near.

Conclusions

Although our study has limited number of patients its findings suggest it is possible to develop ARC after surgery in almost all adult patients with childhood-onset strabismus associated with suppression, and who have not previously been operated upon, if satisfactory alignment is achieved in adulthood.

KEYWORDS:

• Adult strabismus surgery
• anomalous retinal correspondence
• bagolini striated glasses
• binocular vision
• fusion

Acknowledgments

Previously presented in part at the 77^th Annual Meeting of the Association for Research in Vision and Ophthalmology (ARVO), Ft Lauderdale, Florida, May, 2005. The authors would like to thank Burton Kushner, MD, for assistance with editing this article.

Disclosure statement

The authors have no other conflict of interest with regard to the material in this article.

Additional information

Funding

No financial support was obtained for this study.