Comparison of the immediate with the 24-hour postoperative prism and cover measurements in adjustable muscle surgery: Is immediate postoperative adjustment reliable?

Abstract

I read with interest the article by Bleik and Karam 1 Bleik J.H. Karam V.Y. Comparison of the immediate with the 24-hour postoperative prism and cover measurements in adjustable muscle surgery is immediate postoperative adjustment reliable?. JAAPOS. 2004; 8: 528-533 PubMed Scopus (14) Google Scholar entitled “Comparison of the Immediate With the 24-Hour Postoperative Prism and Cover Measurements in Adjustable Muscle Surgery: Is Immediate Postoperative Adjustment Reliable?” The authors show a statistically significant change in eye position between measurements made immediately after recovery from general anesthesia and those made 24 hours later. However, that difference does not allow one to necessarily conclude that “later or delayed adjustment may be a better option for the strabismus surgeon to obtain satisfactory alignment.” 1 Bleik J.H. Karam V.Y. Comparison of the immediate with the 24-hour postoperative prism and cover measurements in adjustable muscle surgery is immediate postoperative adjustment reliable?. JAAPOS. 2004; 8: 528-533 PubMed Scopus (14) Google Scholar ; In other words, different isn’t the same as better. In fact, sometimes it’s worse. Here’s just one example: I was exercising vigorously the other day after a holiday layoff, and my muscles felt great at the end of the workout. However, by the next day, I could hardly move as my muscles were so sore. If past experience is any indicator, it will be about a week before normal mobility returns, at which point I expect to be more like myself immediately after exercise than myself at 24-hours. In our study, 2 Cogen M.S. Guthrie M.E. Vinik H.R. The immediate postoperative adjustment of sutures in strabismus surgery with comaintenance of anesthesia using propofol and midazolam. JAAPOS. 2002; 6: 241-245 PubMed Scopus (22) Google Scholar we looked at the alignment immediately after surgery, at 2 weeks, and again at 6 weeks postoperatively. We also observed an early drift. However, that effect disappeared over time. From a practical standpoint, what matters most to the patient is the final alignment. For the surgeon, it would be nice to be able to quantify and predict drift. For that reason, and to answer the question posed in their title, it would have been far more useful for the authors to provide longer follow-up of a large-enough sample to allow statistical analysis of drift. We stated that the inability to definitively address this question was a shortcoming of our study. Nonetheless, a high success rate along with many advantages with respect to comfort and convenience make immediate postoperative adjustment of sutures in strabismus surgery an attractive option. Authors’ replyJournal of American Association for Pediatric Ophthalmology and Strabismus {JAAPOS}Vol. 10Issue 3PreviewWe read with appreciation Dr. Cogen’s comment. We agree that different isn’t the same as better. We had shown that the mean drift over the first 24 hours represents a 25% change in the original deviation and, based on that number, we concluded that “the immediate postoperative ocular alignment after adjustable strabismus surgery is significantly different from the 24 hours postoperative alignment….” We also concluded that this significant early drift should be taken into consideration if adjustment is to be made in the immediate postoperative period. Full-Text PDF