Underwent Strabismus Surgery Research Articles

Short-Term Near Stereoacuity Improvements Following Favorable Surgical Alignment in Exotropic and Esotropic Patients

ABSTRACT Purpose Surgical treatment for strabismus is to promote binocular vision, and the study is to evaluate the effect of surgical realignment on near stereopsis in exotropic and esotropic patients. Methods The records of patients who underwent strabismus surgery were retrospectively reviewed. Visual acuity, ocular deviations, fusion control, ocular motility, strabismus subtype and duration, surgery procedures, and stereopsis at before and at one month after surgery were collected. RMANOVA was performed to analyze stereopsis improvement by surgery. A logistic analysis was used to investigate the factors for stereopsis improvement. Results 143 exotropic and 40 esotropic patients were enrolled. The stereopsis was not significantly improved in patients with exotropia (p > .05), but not in esotropic patients (p < .01). Small degree of near deviation (β = 0.01), without vertical surgery (β = 0.11), and the high pre-surgery Titmus (β = −0.44) were related factors for stereopsis improvement in exotropia patients; male (β = 0.21) and the high pre-surgery Titmus (β = −0.36) were related factors for stereopsis improvement in esotropia patients. Conclusion The loss of stereopsis was significantly restored by surgery in esotropia patients and the extent of stereopsis recovery by surgery depends on the deviation at near distance, vertical surgery, and pre-surgery stereopsis in exotropes and on sex and pre-surgery Titmus in esotropes.

Strabismus Surgery Decreases the Risk of Injuries in Pediatric Patients in the OptumLabs Data Warehouse

Previous studies have shown an association between injury risk and strabismus in aged Medicare beneficiaries and children. The injury prevalence in strabismic children was 30% in a study of >10 million patients in the OptumLabs Data Warehouse. The purpose of this study was to determine whether strabismus surgery decreases the risk of injury. Retrospective cohort study. The OptumLabs Data Warehouse is a deidentified, longitudinal health database that was queried for strabismic patients aged <19 years. The patients who underwent strabismus surgery were compared with those strabismic patients who did not undergo surgery for injury. Injury risk (fractures, musculoskeletal injuries, and head injuries) during their insurance enrollment was calculated in the nonsurgical patients after their first strabismus claim and compared with the risk in surgical patients postoperatively. There were 344,794 patients with strabismus. Surgery was performed in 26,459 (7.7%). Esotropia was the most common diagnosis (n=181,195, 52.6%) followed by exotropia (n=161,712, 46.9%) and hypertropia (n=43,831, 12.7%). Within these groups, patients with hypertropia were significantly more likely to undergo surgery (24.2%) compared with patients with esotropia and exotropia (10.2% and 9.6%, respectively). Injuries were diagnosed after the first strabismus claim in 94,960 (29.8%) nonsurgical patients vs 5790 (21.9%) postsurgical patients (P < .001) with a mean follow-up of 4.3 ± 3.1 vs 3.8 ± 3.1 years, respectively. The adjusted hazard ratio for injuries was 0.85 (95% confidence interval [CI]: 0.83-0.87) for the risk of any injury after strabismus surgery. The hazard ratio was significantly decreased after surgery for each type of strabismus: esotropia (0.91, 95% CI: 0.88-0.94), exotropia (0.82, 95% CI: 0.80-0.85), and hypertropia (0.89, 95% CI: 0.85-0.93). Strabismus surgery was associated with a 15% decrease in the risk of physical injury over approximately 4 years of follow-up. Surgery may be a factor in decreasing injury risk in strabismic patients, particularly in exotropia. Given the large number of children with strabismus in the United States, further assessment of strategies such as strabismus surgery to reduce injuries in children with strabismus is needed.

A prospective study of treatments for adult-onset divergence insufficiency–type esotropia

To describe 10-week and 12-month outcomes following treatment for divergence insufficiency-type esotropia in adults. In this prospective observational study, 110 adults with divergence insufficiency-type esotropia, with a distance esodeviation measuring 2Δ to 30Δ and at least 25% larger at distance than near, and binocular diplopia present at least "sometimes" at distance, were enrolled at 28 sites when initiating new treatment. Surgery, prism, or divergence exercises/therapy were chosen at the investigator's discretion. Diplopia was assessed at enrollment and at 10-week and 12-month outcome examinations using a standardized diplopia questionnaire (DQ). Success was defined as DQ responses of "rarely" or "never" when looking straight ahead in the distance, with no alternative treatment initiated. Of the 110 participants, 32 (29%) were prescribed base-out prism; none had received prior treatment for esotropia. Success criteria were met by 22 of 30 at 10weeks (73%; 95% CI, 54%-88%) and by 16 of 26 at 12months (62%; 95% CI, 41%-80%). For the 76 (68%) who underwent strabismus surgery (82% of whom had been previously treated with prism), success criteria were met by 69 of 74 at 10weeks (93%; 95% CI, 85%-98%) and by 57 of 72 at 12months (79%; 95% CI, 68%-88%). In this study cohort, both base-out prism as initial therapy and strabismus surgery (usually following prism) were successful in treating diplopia for most adults with divergence insufficiency-type esotropia when assessed during the first year of follow-up.

Health-related quality of life and anxiety associated with childhood intermittent exotropia before and after surgical correction

BackgroundIntermittent exotropia (IXT) is the most common form of exotropia in children. In addition to cosmetic effects and loss of stereoscopic function, IXT may negatively impact the psychological well-being of children and their parents. The purpose of this study was to assess the patient-reported outcomes of Chinese children with IXT before and after strabismus surgery.MethodsThe records of children with IXT who underwent strabismus surgery at the Zhongshan Ophthalmic Center of Sun Yat-sen University, China over the period from January 1, 2016 to December 31, 2018 were prospectively recruited. All children underwent ophthalmic and orthoptic examinations, including the prism and alternate cover test, fusion function by synoptophore, stereoacuity and Newcastle control score. Two patient-reported outcome measures were used: the intermittent Exotropia Questionnaire (IXTQ) to measure disease-specific health-related quality of life (HRQOL) and the Hospital Anxiety and Depression Scale (HADS) to measure anxiety and depression. Patient-reported outcome measurements were made before and after surgery with responses from children and their parents.ResultsA total of 389 children were eligible for inclusion (47.8% male, 52.2% female, mean + SD age = 8.17 ± 2.81). Preoperative IXTQ scores in both children (48.21 ± 26.2) and their parents (44.6 ± 25.68) were significantly correlated with near stereoacuity (P = 0.029 and P = 0.015, respectively). The angle of deviation at near vision showed a negative linear relationship with visual function (P = 0.026) and psychological (P = 0.019) scores as well as opinions regarding surgery (P = 0.024). HADS scores (anxiety scale score: 11 ± 2.92, depression scale score: 10.44 ± 2.9) were also related to near stereoacuity (P < 0.05). After surgery, both children’s (74.83 ± 16.59) and parents’ (68.57 ± 17.06) IXTQ scores significantly improved (p<0.01). Children’s IXTQ scores were related to the angle of deviation at distance, and their psychological and visual function scores showed a negative relationship with the angle of deviation at near vision (P < 0.05).ConclusionChildren and parents’ HRQOL and HADS were associated with near stereoacuity. Parents usually attend more readily to the angle of deviation at near in their IXT children. HRQOL improved significantly after surgery and can be used as one of the indices for preoperative evaluation but is not recommended as a criterion for surgical intervention.

Factors leading to loss to follow-up after strabismus surgery in children

To assess risk factors for loss to follow-up (LTFU) and identify obstacles to follow-up care in these patients. The medical records of all children (<18years old) who underwent strabismus surgery over a 6-year period at a single institution were reviewed retrospectively. Patients were considered LTFU if they failed to attend a follow-up appointment between 3weeks and 6months postoperatively. Variables collected for all patients included age, sex, race/ethnicity, and insurance type. A telephone survey of parents/guardians of all patients LTFU was conducted to determine potential barriers to follow-up care. Demographic information was compared between those not LTFU and those LTFU as well as those LTFU and those LTFU who completed the survey. Reasons for LTFU were quantified and classified by category. Patients LTFU were significantly more likely to be black than white or Asian and have state or government-based insurance rather than private or employer-based insurance. The most common reasons cited for not following-up included perceived positive outcome (47%), work conflicts (37%), transportation issues (30%), travel time (30%), and having forgotten (27%). Patients were LTFU because parents or guardians perceived follow-up as unnecessary, were faced with scheduling or transportation impediments, or simply forgot to appear. Possible remedies include increasing education through teach-back, offering telemedicine appointments, and sending multiple appointment reminders.

IMPACT OF STRABISMUS SURGICAL CORRECTION ON QUALITY OF LIFE IN THE PATIENTS ADMITTED IN DR. M.K. SHAH MEDICAL COLLEGE AND RESEARCH CENTRE, AHMEDABAD

Background: Patients with strabismus often suffer from several psychosocial and emotional consequences. Strabismus surgery address both the functional and psychosocial complaints as both these parameters affect patients' quality of health. Aims &amp;objectives: To assess change in quality of life after surgical correction Methodology: This prospective study was conducted among 50 patients who underwent strabismus surgery at the Ophthalmology Department of Dr. M.K. Shah Medical College and Research Centre, Ahmedabad. Information regarding selfesteem, self-condence, self-assessment of intelligence, effect on employment options, and interpersonal relationships. Quality of life was measured through SF-8 questionnaire. Assessment was done preoperatively and at three months after surgery for any change in these parameters. Results: Mean age of 37.2 ± 10.2 years were enrolled. About 58.0% were female. Only 5 out of 50 (10.0%) experienced preoperative diplopia. Majority of the patients responded that strabismus caused embarrassment (86.0%), trouble in eye contact (86.0%), negative self-esteem (80.0%), camouage (70.0%). After surgery, 49 (98.0%) patients were satised. Improvement in self-esteem, ability to meet new people, relationship and employment, were reported by 43 (86.0%), 31 (62.0%), 12 (24.0%) and 5 (10.0%) and patients. SF-8 scores subscales (except bodily pain, vitality, role emotional subscales) were statistically signicant differences (P&lt;0.05). The average postoperative utility value was 0.86 ± 0.23 with gain of 0.12 ± 0.14 gain. Conclusion: Patients with strabismus have psychosocial difculties. Strabismus corrective surgery causes signicant psychosocial and functional benets and improve the quality of life.

Effect of Topical Brimonidine 0.15% on Conjunctival Injection after Strabismus Surgery in Children.

Purpose To investigate the effects of topical brimonidine 0.15% instillation on conjunctival injection after strabismus surgery in children. Methods We retrospectively analyzed 63 Korean children who underwent strabismus surgery for intermittent exotropia. Patients received topical brimonidine 0.15% after surgery for up to 4 weeks. Conjunctival injection was objectively assessed using a software that automatically scored the region of interest from the image of the bulbar conjunctiva. Conjunctival injection scores were compared with those of the control group who were not prescribed topical brimonidine. Results The mean scores of conjunctival injection after rectus muscle recession and resection were significantly lower in the brimonidine group than the controls at 4 weeks after surgery (P = 0.008 and 0.046, respectively). There was no significant difference in intraocular pressure between the two groups. No adverse effects, such as dry mouth, fatigue/drowsiness, headache, sedation, hypotension, or bradycardia, were reported. Conclusions Administration of topical brimonidine 0.15% after strabismus surgery is efficacious and safe in reducing postoperative conjunctival injection.

CALCIUM ADENOSINE 5’ TRIPHOSPHATASE ENZYME ACTIVITY IN EXTRAOCULAR MUSCLES IN STRABISMUS

OBJECTIVE: This study aims to assess and compare the level of the calcium adenosine 5’-triphosphatase (Ca2+-ATPase) enzyme activity in resected extraocular muscles of strabismus and control groups.MATERIAL AND METHODS: The level of Ca2+-ATPase enzyme activity was evaluated in the extraocular horizontal muscles resected from twenty eyes of 19 patients who underwent strabismus surgery (group 1) and extraocular horizontal muscles samples taken from five eyes of 5 corneal transplant donors (control group - group 2). Enzyme activity was measured via inorganic phosphate (Pi) levels released during Ca2+-ATPase activity.RESULTS: The average activity was calculated as 100.07±12.75 nmol Pi mg-1 0.90min-1 in group 1 and as 165.94±13.60 nmol Pi mg-1 0.90 min-1 in group 2. The enzyme activity in group 1 was significantly lower than in group 2 (p &amp;lt;0.01).CONCLUSIONS: The low level of Ca2+-ATPase enzyme activity in muscles that were resected during strabismus surgery might be an indicator for their possible role in pathophysiology of strabismus.

Acute Acquired Comitant Esotropia Type 2 - A Retrospective Analysis

Acute acquired comitant esotropia (AACE) is an uncommon form of strabismus. The main characteristics of AACE Type 2 in childhood are: acute onset of strabismus around 3 years of age, large and comitant angle of strabismus, absence of accommodative component, hyperopia of not more than 3 dpt, and measurable stereopsis. Strabismus surgery is urgently indicated in AACE Type 2 in order to avoid maldevelopment or loss of stereopsis. Therefore, in order to better describe the characteristics of AACE Type 2, we performed a retrospective analysis of patients previously seen in our clinic. Retrospective analysis of data from patients who underwent strabismus surgery between October 2011 and September 2019 due to suspected AACE Type 2 could be confirmed during postoperative visits by evaluating ocular alignment and stereopsis at our hospital. Analysed data included: age and symptoms at first visit, visual acuity, refractive status, correction by glasses, age at surgery, period of time between first symptoms and surgery, surgical procedure, stereopsis and angle of strabismus (before surgery and 1 day, 3 months, and 12 months after surgery). Ethical approval was obtained from the Cantonal Ethics Committee of Zurich. 18 patients (12 male, 6 female) with mean hyperopia of 1.4 ± 0.6 dpt were identified as meeting the inclusion criteria during the defined time period. Amblyopia was present at first assessment in two patients. Strabismus surgery was performed at 2.0 to 11.1 years of age and between 0.4 and 24.6 months after onset of symptoms. Surgery was performed within 6 months after onset of symptoms in 12/18 children. Before surgery, angle of strabismus at near was measured as 38 ± 10 prism diopters (PD) and was reduced after surgery to 3 ± 3 PD at 3 months and 2 ± 2 PD at 12 months. Stereopsis was confirmed in 5/18 patients one day after surgery and in 18/18 patients 12 months after surgery. Our analysis showed that our patients with diagnosis of AACE Type 2 had mild hyperopia and large comitant non-accommodative esotropia; prognosis for recovery of stereopsis is excellent. Preoperative amblyopia does not exclude the diagnosis of AACE Type 2. Therapeutic intervention is advisable within a short period of time after first symptoms and the diagnosis of AACE Type 2.

Anaesthesia Management of a 6-year Child with Leigh Syndrome undergoing Strabismus Surgery

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Pediatrik Şaşılık Cerrahisinde Okülokardiyak Refleks İnsidansını Etkileyen Faktörler: Retrospektif Çalışma

INTRODUCTION: Oculocardiac reflex (OCR) activation is common during the strabismus surgery. As a result of the OCR, sinus bradycardia, atrioventricular block, ventricular fibrillation and even asystole may occur. Pediatric patients are also more vulnerable to harmful effects of this reflex. The aim of this study was to determine the possible risk factors affecting the incidence of OCR in pediatric patients undergoing strabismus surgery. METHODS: The medical records of the pediatric patients who underwent strabismus surgery between January 2015 and September 2018 were retrospectively reviewed. Operations performed by only one surgeon. OCR was defined as a more than 20% reduction in HR induced by the extraocular muscle (EOM) manipulation. Demographic data, duration of surgery, history of any previous strabismus surgery and possible development of OCR, anesthesia management, neuromuscular blocker and anesthetic drugs used for the anesthesia induction and maintenance as well as the airway management, the number of operated eyes, and also the muscle types of the patients were all recorded. Risk factors for OCR were evaluated by logistic regression analysis. RESULTS: Out of 92 pediatric patients who were initially evaluated, six were excluded from the study because their files were missing. A total of 86 patients were included in the study. During surgery, OCR occurred in 29 (33.7%) patients. The absence of administering benzodiazepine for premedication (p=0.03) and neuromuscular blocker after induction (p=0.046) in pediatric patients are specified as independent risk factors. We found that the use of a neuromuscular blocker and benzodiazepine in premedication reduced the risk of OCR by 3.64 and 3.11 times, respectively. DISCUSSION AND CONCLUSION: The incidence of OCR may decrease with preventive measures such as neuromuscular blocker application, premedication with benzodiazepine in strabismus surgeries.

Initial Postoperative Alignment in Strabismus Related to Thyroid Eye Disease.

To investigate the surgical outcome according to the initial postoperative angle of deviation in patients with thyroid eye disease. The medical records of patients who underwent strabismus surgery were retrospectively reviewed. The patients were divided into overcorrection (> 5 prism diopters [PD]), full correction, or undercorrection (> 5 PD) groups, according to the angle of deviation on postoperative day 1. The surgical outcome was considered successful when there was no diplopia vertically (< 5 PD) and horizontally (< 10 PD) at primary gaze. Surgical success rates were evaluated according to the initial postoperative angle of deviation at the final visit. Seventy-eight patients were enrolled in this study. The mean age of the patients was 53.4 ± 9.5 years, and the mean follow-up duration was 17.4 ± 8.7 months. There were 51 patients with hypotropia and 27 patients with esotropia. Success rates for hypotropia were higher in the undercorrection (80.0%) and full correction (66.7%) groups than in the overcorrection (35.7%) group on postoperative day 1 (P = .02). Regarding esotropia, the success rates were higher in the undercorrection (84.6%) and full correction (83.3%) groups than in the overcorrection (37.5%) group on postoperative day 1 (P = .02). Reoperation for residual or overcorrected strabismus was performed in 15 patients (29.4%) with hypotropia and 7 patients (25.9%) with esotropia. Intended minimal undercorrection or full correction after hypotropia and esotropia surgery during early postoperative periods could improve surgical success rates in patients with thyroid eye disease. [J Pediatr Ophthalmol Strabismus. 2021;58(1):23-27.].

Outcomes of surgical management of intermittent exotropia in a paediatric age group—a retrospective study in a multi‐ethnic metropolitan population

AbstractPurposeIntermittent exotropia is one of the most common types of strabismus in children especially in Asian and South Asian populations. Prevalence of exotropia in this group is estimated to range from 7–18.5× higher than esotropia. Spontaneous resolution is rare and if neglected may lead to loss of Binocular Single Vision (BSV) and negative psychosocial consequences. We aim to evaluate the outcomes of surgical management for intermittent exotropia at a unit in Birmingham (UK), an area unique for its high non‐White ethnic population (43%), majority of who are Asian/South‐Asian.MethodsRetrospective case notes review of patients diagnosed with intermittent exotropia who underwent strabismus surgery in 2019–2020 by two surgeons using two different surgical approaches with a 3 month follow‐up. Measures included pre‐ and post‐operative visual acuity and stereopsis, surgical indications, near and distance strabismus angle with refractive correction, type of surgery performed and parental satisfaction at follow‐up.ResultsNineteen children underwent surgery during this period with a mean age of 7 range (4–12). Eighteen patients had surgery for functional reasons and one for cosmetic. Two patients recovered BSV where previously Frisby negative, remaining patients maintained BSV. The mean preoperative near and distance exodeviation in prism dioptres (PD) was 30.16 and 34.47, respectively. The mean postoperative near and distance exodeviation was 1.53 PD &amp; 5.16 PD, respectively at 3 months. Two patients developed suture granulomas which resolved with steroid drops post‐operatively. No significant difference between the two surgical techniques was noted. In all cases, parents were satisfied with the results.ConclusionsOutcomes in our multi‐ethnic population have been excellent in terms of improvement in exodeviation and maintenance of BSV. Long‐term follow‐up is required to see how many patients will show evidence of recurrence requiring reoperation and whether ethnicity impacts this.

Surgical Outcomes of Exotropic Duane Retraction Syndrome From a Tertiary Eye Care Center.

To report surgical outcomes of patients with exotropic Duane retraction syndrome. A retrospective review of the medical records from patients with exotropic Duane retraction syndrome who underwent strabismus surgery and had at least 2 months of postoperative follow-up was conducted. Surgical success was defined as a postoperative horizontal deviation within 8 prism diopters (PD), abnormal head posture (AHP) less than 5 degrees, and a two-step decrease in overshoots. Seventy-three patients with exotropic Duane retraction syndrome (38, 52% male, mean age 14 ± 7.9 years) met the study criteria. Unilateral type 3 Duane retraction syndrome was seen in 56 (77%) patients and type 1 in 14 (19%) patients. The mean follow-up period was 22 weeks (range: 8 to 209 weeks). Unilateral and bilateral lateral rectus recession were performed in 48 (65%) and 25 (34%) patients, respectively. In addition to recession, a lateral rectus Y-splitting was performed in 42 (56%) patients. Five patients underwent differential medial rectus and (larger) lateral rectus recession to alleviate severe globe retraction. The mean primary position reduced from 23 PD (CI: 19.6 to 26 PD) preoperatively to 9 PD (CI: 7.02 to 11.02 PD) postoperatively (P < .0001). Postoperatively 50% of patients were orthotropic in the primary position. Surgical success for primary position deviation, AHP, and overshoots were achieved in 74%, 81%, and 71% of patients, respectively. In the current study, type 3 Duane retraction syndrome was the most common subtype necessitating surgery for exotropic Duane retraction syndrome. Good surgical outcomes were obtained for various indications. Unilateral or bilateral lateral rectus recession was successful in improving motor alignment and AHP. The addition of lateral rectus Y-splitting corrected overshoots greater than grade 2 in most patients with exotropic Duane retraction syndrome. [J Pediatr Ophthalmol Strabismus. 2021;58(1):9-16.].

Outcomes in accommodative esotropia with a high AC/A ratio.

The purpose of this retrospective cohort study was to report the outcomes of high AC/A ratio accommodative esotropia (AET) among children. The medical records of all children <19 years diagnosed with accommodative esotropia and a high AC/A ratio while residing in Olmsted County, Minnesota, from January 1, 1975, through December 31, 2004, were retrospectively reviewed. A total of 512 patients were diagnosed with AET during the 30-year study period, of which 395 (77.1%) had fully accommodative ET, 117 (22.8%) had partially accommodative ET and 106 (20.5%) had a high AC/A ratio. Of the 93 (87.7 %) high AC/A patients managed with bifocals, 50 (53.8 %) discontinued their use after a mean of 58.7 (range: 5.6-229) months. The Kaplan-Meier rate of discontinuing bifocals was 24.5% at 3 years, 36.4% at 5 years, and 61.4% at 10 years. Patients who discontinued bifocals were more likely to have had strabismus surgery (44% vs 18.6%, p = 0.009) than those who did not discontinue bifocals. The high AC/A patients managed with bifocals achieved similar stereoacuity outcomes to those who did not wear bifocals (p = 0.65) and were no more likely to require surgery (p = 0.13). Among this cohort of children with accommodative esotropia and a high AC/A ratio, bifocal use was discontinued in the majority of children within 10 years, and more commonly among those who underwent strabismus surgery. The use of bifocals was not associated with a higher likelihood of undergoing surgery or enhanced stereopsis compared to those who did not use them.

Wright hang-back recession with fibrin glue compared with standard fixed suture recession for the treatment of horizontal strabismus

ObjectiveTo evaluate the clinical safety and efficacy of the novel Wright hang-back recession with fibrin glue for the treatment of horizontal strabismus. Study DesignRetrospective, case-controlled clinical study comparing surgical outcomes of the Wright hang-back rectus recession with fibrin glue (WHBG) versus standard fixed suture rectus recession (SFR). MethodsMedical records of all patients who underwent strabismus surgery by one strabismus surgeon between 2016 and 2018 for horizontal deviations only, including cases of WHBG (group 1) or SFR (group 2), were reviewed. Good surgical outcome was defined as a postoperative deviation ≤10 prism diopters (PD) at a minimum 2 months of follow-up. Results32 eyes of 17 patients underwent WHBG and 32 eyes of 17 patients underwent SFR; in each group, 35% had esotropia and 65% had exotropia. Mean preoperative deviations between groups were similar: esotropia 25.5 PD and exotropia 26.6 PD in WHBG; esotropia 28.3 PD and exotropia 23.8 PD in SFR. The mean postoperative deviation was <7 PD for both groups. Good surgical outcomes were similar between groups, 16/17 (94%) in WHBG and 15/17 (88%) in SFR, with no complications. ConclusionsWHBG was safe and effective with postoperative results similar to SFR. WHBG has an important advantage, eliminating the complication of retinal perforation that can occur with SFR while avoiding under- or overcorrection that can occur with traditional hang-back recession. This technique increases patient safety without sacrificing surgical outcomes and is especially useful in patients with thin sclera such as patients with high myopia or with difficult posterior exposure.

Effect of single-dose dexmedetomidine on the incidence of emergence delirium after sevoflurane-based anesthesia in children undergoing strabismus surgery

ABSTRACT Backgroun: Though Emergence Delirium (ED) in children is a short duration, often self-limited, episodes, its prevention is essential. This study aims to evaluate the effect of single-dose dexmedetomidine on the incidence of ED in pediatrics who underwent strabismus surgery under sevoflurane-based anesthesia. Methods: The study consisted of 70 ASA I–II children who were 3–7 years old and scheduled for strabismus correction surgeries under sevoflurane anesthesia. The clinical trial registry is PACTR201911530033705, registered on the 3rd of November, 2019. Patients were randomly allocated into two groups (dexmedetomidine and control groups). Patients were administered either dexmedetomidine (0.3 µg/kg intravenous in 10 ml normal saline) or 10 ml normal saline, ten minutes before the end of the procedure (before discontinuation of sevoflurane). Our primary aim was to measure the incidence of ED. Watcha and PAED scores were measured simultaneously with FLACC score on arrival to PACU every ten minutes until 30 minutes, then at discharge. Besides, recovery time from anesthesia, length of PACU stay, parent’s satisfaction, and adverse effects were also recorded. Results: The incidence of ED was 17.6% and 57.6% in groups D and C, respectively. The Watcha and PAED scores were significantly higher in group C during PACU stay while FLACC score was significantly higher in group C on PACU arrival. Despite the significant delay of anesthetic recovery (p < 0.001), PACU stay was significantly shortened (p < 0.001) in group D. Parent’s satisfaction score was significantly better in group D (p = 0.002) without significant differences between both groups regarding adverse effects. Conclusions: This study demonstrates that a single dose of dexmedetomidine is effective in prophylaxis against ED in children after sevoflurane-based anesthesia. Despite its association with delayed recovery, dexmedetomidine shortened PACU stay and could be used safely in children.

Conjunctival incision management for strabismus surgery in the post–corneal neurotization patient

We report 2 patients who underwent strabismus surgery following corneal neurotization for neurotrophic keratopathy. Strabismus surgery in such cases presents unique challenges because of the potentially complicated motility problems arising from underlying neurologic or orbital processes. We consider the management of conjunctival incisions for strabismus surgery in these patients.

Effect of magnesium supplementation on emergence delirium and postoperative pain in children undergoing strabismus surgery: a prospective randomised controlled study

BackgroundThe benefits of intraoperative magnesium supplementation have been reported. In this prospective, randomized study, the effects of magnesium supplementation during general anaesthesia on emergence delirium and postoperative pain in children were evaluated.MethodsA total of 66 children aged 2 to 5 years who underwent strabismus surgery were assigned to the magnesium or to the control group. Preoperative anxiety was assessed using the modified Yale Preoperative Anxiety Scale. After anaesthesia induction, the magnesium group received an initial loading dose of 30 mg/kg magnesium sulphate over 10 min and, then, continuous infusion of 10 mg/kg per h until 10 min before the end of the surgery. The control group received an equal volume of normal saline via the same regimen. The Paediatric Anaesthesia Emergence Delirium (PAED) score, pain score, and respiratory events were assessed at the postanaesthetic care unit.ResultsData obtained from 65 children were analyzed. The PAED and pain scores of the two groups did not differ significantly. There were 26 of 33 (78.8%) and 27 of 32 (84.4%) children with emergence delirium in the control and the magnesium groups, respectively (odds ratio 0.69, 95% CI 0.19–2.44; p = 0.561). The preoperative anxiety score was not significantly correlated with the PAED score. The incidence of respiratory events during the emergence period did not differ significantly between the two groups.ConclusionsMagnesium supplementation during anaesthesia had no significant effects on the incidence of emergence delirium or postoperative pain in children undergoing strabismus surgery.Trial registrationClinicalTrials.gov (NCT03132701). Prospectively registered May 8, 2017.

Strabismus surgery in Angelman syndrome: More than ocular alignment.

PurposeTo report and evaluate strabismus surgery in children with Angelman syndrome, in order to optimize and standardize surgical approach. Other purposes are to understand the possible relation between ocular findings and motor ability, and between improvement in ocular alignment and changes in motor skills in this population.DesignObservational cross-sectional study.MethodsMedical records of pediatric patients with Angelman syndrome, who underwent strabismus surgery, were investigated. Collected data included: genotype, gender, age at the time of surgery, refractive error, pre-operative strabismus, surgical procedure, surgical outcome, gross and fine motor development assessment pre- and post-operatively.ResultsSeventeen subjects, aged 3–15 years, were investigated. Fourteen patients were exotropic, three esotropic. Most patients presented astigmatism. Considering the exaggerated response to standard amounts of surgery and the risk of consecutive strabismus on long term follow-up reported by previous studies in children with developmental delay, a reduction of the amount of strabismus surgery was applied. Post-operatively, all patients presented with a significative reduction of the baseline deviation angle, with all esotropic patients and 7 exotropic patients (59%) achieving orthotropia. The surgical outcomes were variable according to the type and the amount of baseline strabismus, but no case presented with exaggerated surgical response. At baseline, patients showed important delays in all motor abilities, and, post-operatively, presented a significant improvement in walking and fine motor tasks. Pre- and post-operative motor abilities were negatively correlated to astigmatism, anisometropia, and amount of deviation.ConclusionsAccording to our data, the standard nomograms for strabismus surgery may be successfully applied in subjects with Angelman syndrome and exotropia. Our data suggest that the reduction of the deviation angle improves motor skills in strabismic pediatric patients with Angelman syndrome.