Results of Re-operation on the Deviated Eye in Patients with Sensory Heterotropia

Abstract

PurposeTo evaluate the result of re-operation on the deviated eye of recurred, consecutive or undercorrected sensory strabismus after surgery.MethodsThe medical records of 11 patients who had received second strabismus operation on the deviated eye due to recurred, consecutive or undercorrected sensory strabismus were studied retrospectively.ResultsAmong the 11 patients, five patients were operated for recurred exotropia after surgery of sensory exotropia (group 1), two for consecutive exotropia after surgery of sensory esotropia (group 2), and four for undercorrected esotropia after surgery of sensory esotropia (group 3). Re-operation was performed 19.2±12.6 years after the first operation and the mean preoperative deviation before re-operation was 30.0±8.66 prism diopters (PD), 32.5±10.6PD, and 32.5±8.66PD, respectively. In all cases, a small amount of recession or resection compared with the usual surgical dosage was applied in re-operation on the deviated eye. The mean follow-up period after re-operation was 12.3±14.2 (1-48 months). Among the 11 patients, postoperative deviations less than 10PD were achieved postoperatively in 8 (72.7%) at 1 month and of the 8 patients with follow-up data beyond 6 months, 5 (62.5%) showed orthotropia within 10PD at 6 months or later.ConclusionsThe surgical result of re-operation on the deviated eye of recurred, consecutive or undercorrected sensory strabismus after the first surgery was satisfactory in spite of the reduced amount of surgical correction compared with the surgical dosage recommended for the non-operated eye.

Effect of Visual Acuity on the Surgical Outcomes of Secondary Sensory Strabismus

“…4 In addition, long-term maintenance of ocular alignment in sensory strabismus is expected to be poor, and recurrence is high due to the low possibility of fusion gain. 11,12 However, surgery should not be considered only an aesthetic procedure, but also a reconstructive surgery.…”

“…Because the improvement of binocular function is mandatory for higher success in strabismus surgery, long-term maintenance of ocular alignment is difficult after surgical correction of sensory strabismus due to its unique nature. 4 …”

Az Gören Olgularda Şaşılık Cerrahisi

“…Görme azlığı nedeniyle cerrahi öncesi ölçümlerin doğru yapılmasındaki güçlükler, tekrar kayma veya aşırı düzelme durumunda birden fazla cerrahi olasılığı, ilk cerrahide oluşan yapışıklıklar nedeniyle ikinci cerrahinin zorluğu ve sağlam gözün sıklıkla kullanılmak istenmemesi bu faktörlerden bazılarıdır. 5,7,[10][11][12] Tüm olumsuzluklara rağmen bu konuda yapılan çalışmalar yine de teşvik edici olup az gören gözlerde %90,6'lara varan cerrahi başarı oranları bildirilmiştir. 9,12-14 Gusek-Schneider ile Boss'un 15 sekonder duyusal şaşılık olgularını kapsayan çalışmalarında hasta memnuniyetlerinin tam olduğu tespit edilmiştir.…”

“…10,12 Cerrahi sonrası uzun dönemde paralelliğin korunması, özellikle az gören ve füzyon potansiyeli olmayan ET olgularında ardıl kaymanın gelişmemesi için az düzeltme, XT olgularında ET olgularından farklı olarak fazla düzeltme gerektiği ileri sürülmektedir. 6,16,17 Sonucu tahmin edilemeyecek bu tip olgularda ayarlanabilir sütür cerrahisi bir seçenek olmakla birlikte Park ve arkadaşlarının 18 duyusal XT'li olgularda yaptıkları karşılaştırılmalı çalışmada başarı oranları arasında istatistiksel anlamda bir fark olmadığı bildirilmiştir.…”

Exotropia

“…Further surgery on the previously operated eye can be successful, taking into account an increased dose response and the need for smaller amounts of surgery (Kim et al 2008). Acute overcorrection and undercorrection can be managed conservatively with prisms, if fusion is present, or by botulinum toxin.…”